Section 9. Strategic Objectives and Performance Goals for the Plan Administration (Section 2107)

• Strategic Objectives
• Performance Goals
• Objective Measurement of Performance Measures
• Summary of the District’s Comprehensive Strategy to Include the Public in its Decision-making Process
• Public Involvement in Program Design
• Public Involvement in Program Implementation
• Mechanism for Ongoing Public Involvement

9.1. Describe strategic objectives for increasing the extent of creditable health coverage among targeted low-income children and other low-income children. (Section 2107(a)(2))

Strategic Objectives

• Strategic Objective 1: The District will achieve at least 5 percent of its projected enrollment of CHIP eligible children within the first year of implementation of the eligibility expansion.
• Strategic Objective 2: Within the first year of the eligibility expansion and its associated outreach strategy, the District will identify and enroll at least 35 percent of those children who are: (a) uninsured, and (b) currently Medicaid-eligible but not enrolled.
• Strategic Objective 3: Fifty percent of CHIP-enrolled children will have self-selected an HMO and a primary care provider within the first year of enrollment.
• Strategic Objective 4: Those newly enrolled in CHIP and regular Medicaid (income based) will express satisfaction with the new enrollment process.
• Strategic Objective 5: The District will develop and implement a process for determining the effectiveness of (a) the enrollment process, and (b) the City-wide outreach strategy.

9.2. Specify one or more performance goals for each strategic objective identified: (Section 2107(a)(3))

Performance Goals

• Performance Goal for Strategic Objective 1: The District will collect data on the number of CHIP-eligible children enrolled in the program on a monthly basis.
• Performance Goal for Strategic Objective 2: The District will collect data on the number of new Medicaid-eligible and CHIP eligible enrollees on a monthly basis.
• Performance Goal for Strategic Objective 3: The District’s Medicaid Agency will monitor data on CHIP enrollees and whether or not they were selected enrollments or default enrollments on a monthly basis.
• Performance Goal for Strategic Objective 4: The District will capture information related to consumer satisfaction with the eligibility determination process through its managed care enrollment broker. The District is considering developing a questionnaire for this purpose.
• Performance Goal for Strategic Objective 5: The District will: (a) the District will work through its managed care enrollment broker to elicit information from customers related to satisfaction with the eligibility determination process. The City is considering developing a questionnaire for this purpose; and (b) the City will include a question (or series of questions) on its new Medicaid/CHIP application that will elicit from the applicant how he or she found out about the program and whether he/she received community-based assistance with completing the process. The Medicaid Agency will desk audit enrollment forms for customer responses every six months and tabulate the data.

9.3. Describe how performance under the plan will be measured through objective, independently verifiable means and compared against performance goals in order to determine the state’s performance, taking into account suggested performance indicators as specified below or other indicators the state develops:

(Section 2107(a)(4)(A),(B))

Objective Measurement of Performance Measures

The District’s baseline for its performance is those measures as stated in this application and relevant appendixes. The Medical Assistance Administration receives numerical data from the Managed Care Organizations (MCOs) on an ongoing basis. This data is summed and tabulated to determine whether targets have been met and to compare MCO performance. Data used in reports developed by the Medical Assistance Administration is readily verifiable through the contracted Managed Care Organizations and may be independently verified through the MCOs. In addition, the Medical Assistance Administration will employ an External Quality Review Organization (EQRO) to independently verify data received form the MCOs.

The Medical Assistance Administration will work through its independent enrollment broker to capture satisfaction with the eligibility determination process. This information may be independently verified through the enrollment broker.

Performance measures that do not lend themselves to numeric summation will be tabulated and maintained by Medical Assistance Administration personnel. These tabulations, as well as the raw data used to develop them, will be maintained on file by the Medical Assistance Administration, and can be made available for independent verification.

Check the applicable suggested performance measurements listed below that the state plans to use: (Section 2107(a)(4))

9.3.1. X The increase in the percentage of Medicaid-eligible children enrolled in Medicaid.

9.3.2. X The reduction in the percentage of uninsured children.

9.3.3. X The increase in the percentage of children with a usual source of care.

9.3.4. X The extent to which outcome measures show progress on one or more of the health problems identified by the state. Problems Identified: Asthma and Lead Poisoning

9.3.5. ~ HEDIS Measurement Set relevant to children and adolescents younger than 19. See 9.3.7 below.

9.3.6. ~ Other child appropriate measurement set. List or describe the set used.

9.3.7. X If not utilizing the entire HEDIS Measurement Set, specify which measures will be collected, such as:

• 9.3.7.1. X Immunizations
• 9.3.7.2. X Well child care
• 9.3.7.3. X Adolescent well visits
• 9.3.7.4. X Satisfaction with care
• 9.3.7.5. ~ Mental health
• 9.3.7.6. X Dental care
• 9.3.7.7. X Other, please list: EPSDT Screening
• 9.3.8. ~ Performance measures for special targeted populations.

9.4. X The state assures it will collect all data, maintain records and furnish reports to the Secretary at the times and in the standardized format that the Secretary requires. (Section 2107(b)(1))

9.5. X The state assures it will comply with the annual assessment and evaluation required under Section 10.1. and 10.2. (See Section 10) Briefly describe the state’s plan for these annual assessments and reports. (Section 2107(b)(2))

District of Columbia Plan for Annual Assessments

The District of Columbia’s Medicaid program will collect data consistent with the reporting requirements of Section 10 of this CHIP application. The District will compile the data into an assessment and evaluation report on an annual basis. Specifically, the District will:

X Track all new Medicaid enrollees along the following indicators: (a) monthly number enrolled; (b) income level; (c) age; (d) race and ethnicity; (e) geographic area of residence with the District; and (f) criteria for Medicaid eligibility

X Collect enrollment information from the two private health insurance initiatives in the District

C Ensure that enrolled children receive Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services consistent with standards set forth in the District’s contractual agreement with its Managed Care Organizations. (See Appendix F: EPSDT Standards set forth in MCO Contracts)

C Implement an HMO Oversight Program designed to evaluate member satisfaction and quality of care and service delivery. (See Appendix G: Description of HMO Oversight Program and Quality Measures)

C Evaluate effectiveness of outreach and public education activities

9.6. X The state assures it will provide the Secretary with access to any records or information relating to the plan for purposes of review of audit. (Section 2107(b)(3))

9.7. X The state assures that, in developing performance measures, it will modify those measures to meet national requirements when such requirements are developed.

9.8. The state assures, to the extent they apply, that the following provisions of the Social Security Act will apply under Title XXI, to the same extent they apply to a state under Title XIX: (Section 2107(e))

9.8.1. X Section 1902(a)(4)(C) (relating to conflict of interest standards)

9.8.2. X Paragraphs (2), (16) and (17) of Section 1903(I) (relating to limitations on payment)

9.8.3. X Section 1903(w) (relating to limitations on provider donations and taxes)

9.8.4. X Section 1115 (relating to waiver authority)

9.8.5. X Section 1116 (relating to administrative and judicial review), but only insofar as consistent with Title XXI

9.8.6. X Section 1124 (relating to disclosure of ownership and related information)

9.8.7. X Section 1126 (relating to disclosure of information about certain convicted individuals)

9.8.8. X Section 1128A (relating to civil monetary penalties)

9.8.9. X Section 1128B(d) (relating to criminal penalties for certain additional charges)

9.8.10.X Section 1132 (relating to periods within which claims must be filed)

9.9. Describe the process used by the state to accomplish involvement of the public in the design and implementation of the plan and the method for insuring ongoing public involvement. (Section 2107(c))

Summary of the District’s Comprehensive Strategy to Include the Public in its Decision-making Process

• The public process for discussing issues related to the development of the District’s CHIP plan is an ongoing one that has been city-wide, open and inclusive.
• All meetings that have been held related to CHIP have been open to the community.
• An article, DC Seeks to Expand Health Care for Needy Children, appeared in the Washington Post on December 9, 1997. (See Appendix H: December 9, 1997 Washington Post Article)
• Specific efforts were made to include members and representatives from the District’s immigrant communities in the planning process. These include: working with the Mayor’s Office of Diversity, the Mayor’s Office of Asian and Pacific Islanders Affairs and the Mayor’s Office of Latino Affairs to ensure that members of these communities were aware of CHIP and that they would send representatives to the public forums.
• Translation services and signing for the hearing impaired were made available at several of the public forums. Specifically, Chinese, Vietnamese and Spanish translators were available.

Public Involvement in Program Design

• The Medicaid Managed Care and Eligibility Committee (MMCEC) of the Mayor’s Health Policy Council took the lead in the District’s public process to involve the community in planning for CHIP. The membership of the MMCEC includes, but is not limited to representatives from the following organizations: The Department of Health, including the DC Medical Asssistnace Administration (Medicaid), DC Dental Association, DC Hospital Association, Blue Cross Blue Shield of the National Capitol Area, and the Medical Society of the District of Columbia.
• The Committee process was, and continues to be, open to all interested community members. (See Appendix I: Summary of Health Policy Council (including background on members).
• For the purpose of discussing issues related to the District’s CHIP plan, the Committee was divided into three Work Groups: (1) The Coverage and Benefits Work Group; (2) The Structure and Administration Work Group; and (3) The Outreach and Education Work Group.
• The Committee and its component Work Groups met several times between September 1997 and December 1998 to evaluate the policy options associated with the development of a CHIP plan. On December 9, 1998, the Committee made final recommendations to the Mayor’s Health Policy Council.
• Upon approval of the Committee’s recommendation (as amended) by the Health Policy Council (December 9, 1997) the Committee proceeded with a series of public forums related to CHIP. (See Appendix J: Medicaid Managed Care and Eligibility Committee Consensus Report; Health Policy Council Recommendation; and Comments of Families USA on Recommendations of the Medicaid Managed Care and Eligibility Committee)
• The Medicaid Managed Care and Eligibility Subcommittee of the Mayor’s Health Policy Council conducted five public forums between January 12, 1998 and January 28, 1998. The purpose of the meetings were: (a) to inform the public about CHIP and options given to states under federal law; (b) to inform the public that the District is planning to expand Medicaid to implement CHIP; (c) to solicit public input related to effective enrollment processes; and (d) to solicit public input related to effective public education and outreach strategies. (See Appendix K: Summary of Health Policy Council and Flyers and Handouts for Public Hearings Conducted by the Medicaid Managed Care and Eligibility Committee of the Mayor’s Health Policy Council)
• A Public Roundtable sponsored by Council member Sandra Allen (Ward 8), Chair of the Committee on Human Services was held in the City Council Chambers on January 27, 1998. A number of groups and some private individuals offered testimony at the Roundtable. (See Appendix L: Flyer Announcing Public Hearings; Statement of Allan S. Noonan, M.D., M.P.H., Director, Department of Health; Statement of Bailus Walker, Jr., PhD, MPH, Chair, Mayor’s Health Policy Council; Statement of Brenda Richardson, Chair, Outreach and Education Work Group; Statement of Jesse Price, Consumer; Statement of Diane Bernstein, President, DC Action for Children; and Statement of Hanita Schreiber, President, Capital Community Health Plan)
• The Department of Health, in partnership with City Council members, conducted a series of public forums between February 12, 1998 and March 16, 1998 in seven of the City’s eight wards. The forums were advertised in the Washington Post on February 12, 1998. (See Appendix M: February 12, 1998 Washington Post Article) Representatives from the Department of Health and the City Council provided information at the meetings. The purpose of these forums was: (a) to ensure city-wide in-put in the CHIP planning process; (b) to inform the public about CHIP and options given to states under federal law; (c) to inform the public that the District is planning to expand Medicaid to implement CHIP; (d) to solicit public input relative to effective enrollment processes; and (e) to solicit public input relative to effective public education and outreach strategies. (See Appendix N: Flyers and News Release Advertising Public Hearings Conducted by the Department of Health and the City Council)
• Representatives from the District’s Medicaid Agency have made themselves available to make presentations upon request. Thus far, approximately six presentations have been made to such groups as: The Use Your Power Parent Group, The Welfare Reform Collaborative, The Washington Parent Group Fund, and DC Foster Care Social Workers.

Public Involvement in Program Implementation

• The Director of the Department of Health and members of the Managed Care and Eligibility Committee of the Mayor’s Health Policy Council will share ongoing oversight responsibilities for CHIP.
• The Outreach and Education Work Group of the Medicaid Managed Care and Eligibility Committee will have continued involvement in the development, implementation and ongoing oversight of the City’s outreach plan as will representatives from key City agencies.

Mechanism for Ongoing Public Involvement

• The District will conduct periodic focus group sessions with consumer groups to evaluate the effectiveness of CHIP and the level of satisfaction with changes in the enrollment process.
• Consumers, providers and other concerned parties will be encouraged to give their input to the Medical Care Advisory Committee which meets on a monthly basis.
• The Managed Care and Eligibility Committee will continue to review CHIP activities during regular meetings.

9.10. Provide a budget for this program. Include details on the planned use of funds and sources of the non-Federal share of plan expenditures. (Section 2107(d))

A financial form for the budget is being developed, with input from all interested parties, for states to utilize.