CARE COORDINATION (as part of the medical home and integrated with community-based services) All CYSHCN have access to Yes Title V 0 None patient and family-centered care (IF YES) How effective are those State Medicaid 1 Weak coordination. policies and procedures? CHIP 2 Moderate Not effective Strong 1 Health Plan/Insurer 3 2 Somewhat effective Provider (please specify) 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No Not applicable to my organization Enter Score: Enter Score: To provide optimal coordination Yes Title V 0 None and integration of services (IF YES) How effective are those State Medicaid 1 Weak needed by the child and family, 2 Moderate policies and procedures? CHIP care coordinators: 1 Not effective Health Plan/Insurer 3 Strong serve as a member of the 2 Somewhat effective Provider (please specify) medical home team, 3 Very effective Family/Consumer assist in managing care Other (please specify) transitions of CYSHCN across settings and OPTIONAL: developmental stages Why? provide appropriate No resources to match the Not applicable to my organization health literacy level, primary language, and culture of CYSHCN and their family Enter Score: Enter Score:
CARE COORDINATION (as part of the medical home and integrated with community-based services) All CYSHCN have access to patient and family-centered care coordination. 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: To provide optimal coordination and integration of services needed by the child and family, care coordinators: serve as a member of the medical home team, assist in managing care transitions of CYSHCN across settings and developmental stages provide appropriate resources to match the health literacy level, primary language, and culture of CYSHCN and their family 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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