Provide care that is effective and Yes Title V 0 None on evidence, where 1 Weak (IF YES) How effective are those State Medicaid applicable. 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: PEDIATRIC PREVENTIVE & PRIMARY CARE (as part of the medical home) None Bright Futures Guidelines for Yes Title V 0 screening and well child care 1 Weak (IF YES) How effective are those State Medicaid including oral health and mental policies and procedures? CHIP 2 Moderate health services are followed. 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 care that is effective and on evidence, where applicable. 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: PEDIATRIC PREVENTIVE & PRIMARY CARE (as part of the medical home) Bright Futures Guidelines for screening and well child care including oral health and mental health services are followed. 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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