A process is in place in the Yes Title V 0 None pediatric medical home to 1 Weak (IF YES) How effective are those State Medicaid ensure that follow-up of a policies and procedures? CHIP 2 Moderate YSHCN is provided 3 6 months 1 Not effective Health Plan/Insurer 3 Strong – after transfer to an adult medical 2 Somewhat effective Provider (please specify) home to confirm transfer and 3 Very effective Family/Consumer elicit feedback on their transition Other (please specify) experience. OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score: Transition quality improvement Yes Title V 0 None includes collaboration and, for (IF YES) How effective are those State Medicaid 1 Weak some YSHCN, co-management policies and procedures? CHIP 2 Moderate between pediatric and adult 1 Not effective Health Plan/Insurer 3 Strong health care providers. 2 Somewhat effective Provider (please specify) 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score:
A process is in place in the pediatric medical home to ensure that follow-up of a YSHCN is provided 3 – 6 months after transfer to an adult medical home to confirm transfer and elicit feedback on their transition experience. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Select “0” for score, above ) 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: Transition quality improvement includes collaboration and, for some YSHCN, co-management between pediatric and adult health care providers. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Select “0” for score, above ) 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:
7_Transition%20to%20Adulthood_In%20DepthFINAL.docx