An individual flow sheet or Yes Title V 0 None registry for identifying 1 Weak (IF YES) How effective are those State Medicaid transitioning YSHCN is policies and procedures? CHIP 2 Moderate maintained by the health plan 1 Not effective Health Plan/Insurer 3 Strong and medical home to track 2 Somewhat effective Provider (please specify) completion of the transition 3 Very effective Family/Consumer process. Other (please specify) OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score: A transition readiness Yes Title V 0 None assessment and plan of care, (IF YES) How effective are those State Medicaid 1 Weak including a medical summary policies and procedures? CHIP 2 Moderate and emergency care plan, are 1 Not effective Health Plan/Insurer 3 Strong first developed when a YSHCN 2 Somewhat effective Provider (please specify) reaches age 14, and then 3 Very effective Family/Consumer regularly updated in partnership Other (please specify) with the youth and her/his family or caregiver. A OPTIONAL: family’s cultural beliefs are respected in the Why? development of the transition No for score, above ) (Select “0” plan. Not applicable to my organization Enter Score: Enter Score:
An individual flow sheet or registry for identifying transitioning YSHCN is maintained by the health plan and medical home to track completion of the transition process. 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: A transition readiness assessment and plan of care, including a medical summary and emergency care plan, are first developed when a YSHCN reaches age 14, and then regularly updated in partnership with the youth and her/his family or caregiver. A family’s cultural beliefs are respected in the development of the transition plan. 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