Systems of Accountability Implementing Children's Health Insurance Programs (1998) / Chapter Skim
Currently Skimming:
Overview of the State Children's Health Insurance Program
Overview of the State Children's Health Insurance Program
Pages 5-18
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From page 5... ...
. After October I, 1997, SCHIP made $24 billion available to states over 5 years, including $20.3 billion for new initiatives based on private insurance coverage and $3.6 billion for Medicaid improvements, such as continuing eligibility for children who were formerly eligible for Supplemental Security Income, and guaranteeing ~ year of Medicaid eligibility.
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From page 6... ...
The committee strongly supports the flexibility and innovation that are built into the SCHIP legislation, provided there are ways to measure the program's impact on a national basis and to ensure that the funds spent actually improve insurance coverage and health outcomes for children. From the beginning, it will be important to learn where states are heading with their spending and services.
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From page 7... ...
/ ( DHHS Regional Offices 7 FIGURE 1 Accountability for SCHIP programs. One-way arrows indicate public accountability specified in The Balanced Budget Act of 1997 (P.L.
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From page 9... ...
Several child health performance measurement and managed care quality improvement activities have implications for SCHIP, including Bright Futures encounter forms and the National Committee on Quality Assurance's expansion of HEDIS child health measures. In addition, HCFA's Quality Improvement System for Managed Care standards and guidelines are in interim final form as of late September 1998.
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From page 10... ...
States vary widely in technical and analytical capacities as well as in their willingness to collect and analyze performance data (Landon et al., 1998; Rosenbaum et al., 19971. Technical problems in the exchange of health care information arise from the variety of software systems used by states, health plans, and other providers, as well as from the cost of new management information systems which can range from $250,000 to $1 million for a basic administrative system and much higher for a full managed care system (Ciotti and Zodda, 19961.
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From page 11... ...
~ I As delegated by plan / ~ Health Care \\ ctitioners J Health Care Services \ / Outreach ~ Enrollment ~ ,/ < Support Services J As delegated by state FIGURE 2 Information flows to support accountability relationships within states for SCHIP programs. Arrows indicate information flows and accountability relationships, as specified in state laws, public policies, and contractual agreements.
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From page 12... ...
Congress provided a basic template for SCHIP accountability systems by requiring states to set strategic objectives and performance goals and to collect performance data as part of their SCHIP plans, and by requiring the Secretary of DHHS to report to Congress by December 2001 on the effectiveness of the state plans (see Box 11. The commitment to using performance data is a critical component of any long-term accountability system (Congressional Budget Office, 19931.
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From page 13... ...
Without a minimum set of comparable data, it will be difficult to establish baseline information and to track changes in the number of uninsured children; to evaluate disparities in health status; to compare the scope of services in different programs, utilization data for different groups, and the quality of care in different health plans; and to collect other information essential for evaluating the success of SCHIP across states. The field of performance measurement is continually improving and is moving toward more outcome-oriented, population-specific, and evidence-based measures.
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From page 14... ...
An initial survey should be implemented quickly to provide a baseline for measuring changes in children's insurance coverage, enrollment, and utilization. A more comprehensive survey should be repeated on an ongoing basis to monitor changes in children's health status and well-being after states implement their SCHIP programs.
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From page 15... ...
Regardless of which state agency takes the lead during the planning process, each state will need to identify the responsible parties and strategies for SCHIP implementation and for technical assistance in developing statewide accountability systems. At a minimum, states will need to specify the agencies and individuals responsible for providing public information about SCHIP; for developing tools and incentives for provider and health plan participation; for evaluating program impact; and for making timely adjustments and modifications to the enrollment process, information and tracking systems, and other administrative components of the program.
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From page 16... ...
Data Collection and Performance Reporting 6. As much as possible, states should delegate the collection and synthesis of SCHIP information to contracted health plans or provider groups, with requirements for independent auditing of these data.
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From page 17... ...
that fulfills the intent of the SCHIP legislation: to provide insurance coverage for uninsured children, to improve their access to high-quality health care services, and, ultimately, to improve their health. REFERENCES Congressional Budget Office (CBO)
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From page 18... ...
National Economic CouncillDomestic Policy Council. Implementation of the Children's Health Insurance Program [WWW Document]
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