Care focuses on overall health, Yes Title V 0 None wellness and prevention of 1 Weak (IF YES) How effective are those State Medicaid secondary conditions, especially policies and procedures? CHIP 2 Moderate for CYSHCN whose care tends 1 Not effective Health Plan/Insurer 3 Strong to center on a particular 2 Somewhat effective Provider (please specify) condition. 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No Not applicable to my organization Enter Score: Enter Score: All children, including CYSHCN, Yes Title V 0 None have access to medically (IF YES) How effective are those State Medicaid 1 Weak necessary services to promote policies and procedures? CHIP 2 Moderate optimal growth and 1 Not effective Health Plan/Insurer 3 Strong development, maintain and avert 2 Somewhat effective Provider (please specify) deterioration in functioning, and 3 Very effective Family/Consumer to prevent, detect, diagnose, Other (please specify) treat, ameliorate, or palliate the effects of physical, genetic, OPTIONAL: congenital, developmental, Why? behavioral, or mental conditions, No injuries, or disabilities. Not applicable to my organization Enter Score: Enter Score:
Care focuses on overall health, wellness and prevention of secondary conditions, especially for CYSHCN whose care tends to center on a particular condition. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer Other (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score: All children, including CYSHCN, have access to medically necessary services to promote optimal growth and development, maintain and avert deterioration in functioning, and to prevent, detect, diagnose, treat, ameliorate, or palliate the effects of physical, genetic, congenital, developmental, behavioral, or mental conditions, injuries, or disabilities. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer Other (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score:
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