Provide health care services Yes Title V 0 None that encourage the family to 1 Weak (IF YES) How effective are those State Medicaid share in decision making, policies and procedures? CHIP 2 Moderate and provide feedback on 1 Not effective Health Plan/Insurer 3 Strong services provided. 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: Perform comprehensive health Yes Title V 0 None assessments. (IF YES) How effective are those State Medicaid 1 Weak policies and procedures? CHIP 2 Moderate 1 Not effective Health Plan/Insurer 3 Strong 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:
Provide health care services that encourage the family to share in decision making, and provide feedback on services provided. 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: Perform comprehensive health assessments. 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:
4_Medical%20Home_In%20DepthFINAL.docx