tDCS Comprehensive Health Plan

DCS CHP AHCCCS Reported EPSDT Performance Measures

Statement/Purpose

The Department of Child Safety Comprehensive Health Plan (DCS CHP) provides and monitors comprehensive and preventive health services for enrolled children and youth through its EPSDT benefit.

Definitions

Arizona Health Care Cost Containment System (AHCCCS): Founded in 1982, the Arizona Health Care Cost Containment System is Arizona's Medicaid program, a federal health care program jointly funded by the federal and state governments for individuals and families who qualify based on income level.

Centers for Medicaid and Medicaid Services (CMS): CMS is part of the U.S. Department of Health and Human Services which administers Medicare and Medicaid in partnership with state governments.

Early Periodic Screening, Diagnostic and Treatment (EPSDT): A comprehensive child health program of prevention, treatment, correction, and improvement of physical and behavioral health conditions for members under the age of 21 The EPSDT services include screening services, vision services, dental services, hearing services and all other medically necessary mandatory and optional services as specified in Federal Law 42 USC 1396d(a) to correct or ameliorate defects and mental illnesses and conditions identified in an EPSDT screening whether or not the services are covered under the AHCCCS State Plan. Limitations and exclusions, other than the requirement for medical necessity and cost effectiveness, do not apply to EPSDT services.

Health Effectiveness Data Information System (HEDIS): A comprehensive set of standardized performance measures established by National Committee for Quality Assurance (NCQA). These measures identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards that allow comparison with other plans.

Policy

DCS CHP assesses its performance to identify opportunities to improve children and youth’s access to EPSDT services and assess its performance relative to other Arizona Medicaid plans. This is accomplished using AHCCCS’ requirements, methodologies and results noted in the AHCCCS Performance Measures and Trends Dashboard or other related publications.

For those measures noted, DCS CHP tailors its programming to exceed AHCCCS minimum requirements, Arizona Medicaid (all health plans) mean for reporting period, and DCS CHP’s prior year performance (if applicable). Planning for future enhancements to the EPSDT Program are delineated in the EPSDT Annual Plan, Workplan and Evaluation and related Performance Improvement Projects (PIPs).

Procedure

As indicated by AHCCCS, methodologies include:

• National Committee for Quality Assurance (NCQA)

• Healthcare Effectiveness Data and Information Set (HEDIS);

• CMS Core Set;

• and those where hybrid methodologies where permitted.