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GAO-11-293R: 

United States Government Accountability Office: 
Washington, DC 20548: 

April 5, 2011: 

The Honorable Max Baucus: 
Chairman: 
The Honorable Orrin Hatch: 
Ranking Member: 
Committee on Finance: 
United States Senate: 

The Honorable Fred Upton: 
Chairman: 
The Honorable Henry A. Waxman: 
Ranking Member: 
Committee on Energy and Commerce: 
House of Representatives: 

Subject: Medicaid and CHIP: Reports for Monitoring Children's Health 
Care Services Need Improvement: 

Medicaid and the Children's Health Insurance Program (CHIP)--two joint 
federal-state health care programs for low-income families and 
children--play a critical role in addressing the health care needs of 
children.[Footnote 1] In 2008, more than 36 million children in the 
United States received health care coverage through Medicaid or CHIP. 
Like all children, children covered by Medicaid and CHIP may have 
health care conditions that could warrant care from primary care or 
specialist providers. At the same time, a significant number of 
children in Medicaid and CHIP may not be receiving basic preventive 
care, which these programs generally cover. For example, we reported 
in 2009 that, on the basis of parents' reports in national surveys, 
about 40 percent of children in Medicaid and CHIP had not had a well-
child checkup over a 2-year period.[Footnote 2] 

Many state Medicaid and CHIP programs and other health care purchasers 
have started initiatives to improve care coordination for children and 
provide children with access to networks of care. For the purposes of 
this report, care coordination is broadly defined as a process in 
which an individual or group helps to arrange a patient's primary and 
specialty health care services.[Footnote 3] Care coordination can be 
provided by primary care providers or through other individuals such 
as social workers or case managers. Care coordination activities can 
include communication--sharing information among participants in a 
patient's care--and linking patients to community resources. Care 
coordination can help children gain access to a network of care, that 
is, a set of providers who are available to help address the primary 
and specialty health care needs of a patient. 

The Centers for Medicare & Medicaid Services (CMS), an agency within 
the Department of Health and Human Services (HHS), oversees state 
Medicaid and CHIP programs at the federal level and collects annual 
reports. States are required, under federal law, to annually report to 
CMS on the provision of a range of preventive, diagnostic, and 
treatment services for eligible children, known as Early and Periodic 
Screening, Diagnostic and Treatment (EPSDT) services.[Footnote 4] 
Under federal law, the EPSDT benefit generally entitles children in 
Medicaid to receive coverage of periodic screening services--often 
termed well-child checkups--that include a comprehensive health and 
developmental history, a comprehensive physical exam, appropriate 
immunizations, laboratory tests, and health education.[Footnote 5] 
Under federal law, states are also required to annually assess the 
operations of their CHIP programs and report to CMS on the results of 
those assessments.[Footnote 6] These reports are important in part 
because they are designed to collect a standard set of information 
about children's health in Medicaid and CHIP from all states, and thus 
serve as a resource for CMS and other stakeholders to monitor 
children's utilization of health care services.[Footnote 7] For 
Medicaid, CMS requires states to submit EPSDT reports (also known as 
CMS 416 reports), which include information on the number of children 
receiving well-child checkups and the number of children referred for 
treatment services for conditions discovered through well-child 
checkups. The CMS 416 reports are used by CMS to monitor states' 
progress in meeting the agency's annual goal that states provide a 
well-child checkup to at least 80 percent of the children eligible to 
receive one.[Footnote 8] CMS, for example, has used CMS 416 reports to 
identify states with low reported rates of service provision for 
purposes of conducting reviews of state EPSDT programs to identify 
needed improvements. For CHIP, CMS requires states to submit a CHIP 
annual report. This report provides a wide range of information about 
state CHIP programs, including states' performance in four areas 
related to services provided to children: receipt of well-child visits 
during the first 15 months of life; receipt of well-child visits in 
the third, fourth, fifth, and sixth years of life; use of appropriate 
medications for children with asthma; and access to primary care 
providers. 

States generally provide Medicaid and CHIP services through two 
service delivery and financing models--fee-for-service and managed 
care. Under a fee-for-service model, states pay providers for each 
covered service for which the providers bill the state. Under a 
managed care model, states contract with managed care plans, such as 
health maintenance organizations, to provide or arrange for medical 
services, and prospectively pay the plans a fixed monthly fee per 
enrollee.[Footnote 9] Concerns have been raised about delivery model 
incentives and health care service utilization; for example, one 
concern is that the fixed payment in managed care models may create an 
incentive to underserve or deny access to needed care. In contrast, 
because providers are paid for each covered service provided in fee-
for-service models, there may be an incentive to provide more services 
to beneficiaries than necessary. As a result, interest in 
understanding access to, and use of, services by delivery model in 
Medicaid and CHIP has been long-standing. 

In the Children's Health Insurance Program Reauthorization Act of 2009 
(CHIPRA), Congress required that we study Medicaid and CHIP children's 
access to primary and specialty care, including the extent to which 
care coordination is provided for children's care in Medicaid and CHIP 
and information on children's access to networks of care. In addition, 
Congress required that we study, as appropriate, information on the 
degree of availability of services for children in Medicaid and CHIP. 
[Footnote 10] This report examines: 

1. the extent to which children in Medicaid and CHIP receive care 
coordination and have access to networks of care, 

2. how selected states are coordinating care for children in Medicaid 
and CHIP, and: 

3. the extent to which required state reports collected by CMS provide 
information on the provision of services to children in Medicaid and 
CHIP. 

We provided a briefing for your staff on the information contained in 
this report on February 3, 2011. (See enclosure I.) As discussed at 
that time, we agreed to issue this report, which transmits and updates 
the information provided at the briefing. 

To examine the extent to which children in Medicaid and CHIP receive 
care coordination and have access to networks of care, we analyzed two 
nationally representative surveys administered by HHS agencies. One 
survey--the National Survey of Children's Health (NSCH)--provides 
information on children's access to care coordination.[Footnote 11] 
The NSCH includes a measure to identify the extent that children 
needing care coordination received effective care coordination. 
[Footnote 12] The second survey--the Medical Expenditure Panel Survey 
(MEPS)--provides information on children's use of, and access to, 
health services and specialists, which we used as a proxy for 
children's access to networks of care.[Footnote 13] To assess the 
reliability of these data, we reviewed relevant documentation and 
interviewed agency officials knowledgeable about the data; we 
determined that the data were sufficiently reliable for the purposes 
of this report. (See enclosure II for additional information on our 
analyses of NSCH and MEPS survey data.) To examine how selected states 
are coordinating care for Medicaid and CHIP children, we selected 5 of 
the 21 states identified in literature and by experts as having 
implemented initiatives in their Medicaid and CHIP programs to improve 
the coordination of children's care.[Footnote 14] We interviewed state 
officials and others involved in these initiatives, such as physician 
associations and advocacy groups that assisted in the implementation 
of the initiatives. The 5 states we selected were Colorado, Illinois, 
New York, North Carolina, and Oklahoma. This judgmental, 
nongeneralizable sample was chosen to (1) include geographic 
diversity, (2) represent a mix of small and large Medicaid and CHIP 
programs, and (3) represent a mix of Medicaid and CHIP programs with 
and without a large proportion of children enrolled in managed care. 
To examine the extent to which annual state reports collected by CMS 
provide information on the provision of services to children in 
Medicaid and CHIP, we assessed federal fiscal year 2008 information 
from the two key summary reports that states are required to submit to 
CMS: the CMS 416 reports and the state CHIP annual reports. 

We conducted this performance audit from September 2009 to April 2011 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

Results in Brief: 

Two nationally representative surveys from 2007 suggest that many 
children in Medicaid and CHIP needing care coordination did not 
receive it, and many needing access to networks of care had a problem 
with accessing the needed services, as the following specifics 
illustrate. 

* Care coordination: NSCH survey data from 2007 reveal that 45 percent 
of children in Medicaid and CHIP needed care coordination services, 
and of this group, 37 percent did not receive it. 

* Access to networks of care: The 2007 MEPS data reveal that 34 
percent of children in Medicaid and CHIP needed care, tests, or 
treatments, and of this group, 12 percent of the children's families 
had problems accessing the needed services. In addition, based on the 
MEPS data, 15 percent of children in Medicaid and CHIP needed to see 
specialists, and of these children, 24 percent had problems seeing the 
specialists they needed to see. MEPS data from 2007 also suggest that 
a greater proportion of children in Medicaid and CHIP and uninsured 
children experienced a problem accessing needed care and needed 
specialists than privately insured children. For example, 12 percent 
of children in Medicaid and CHIP reported problems accessing needed 
care, tests, or treatments, compared to 16 percent of uninsured 
children and 6 percent of privately insured children. 

The five states we examined had initiatives designed to improve care 
coordination for children in Medicaid and CHIP by having a process in 
place for beneficiaries to choose or be assigned to a medical home-- 
typically a primary care provider--and by providing enhanced payments 
to providers of care coordination services.[Footnote 15] Four of the 
five states provided monthly payments--per member per month--to 
providers for each patient covered by the initiative who was enrolled 
with the provider. Other approaches used by the states included 
increased payment rates for certain services, such as office-based 
checkups, and performance-based bonuses or incentive payments for 
meeting or exceeding quality standards. The standards that 
participating providers were required to meet varied among states, but 
included requirements such as having a system in place for patients to 
contact their provider 24 hours a day and 7 days a week, tracking 
referrals to other physicians, and designing care management plans for 
patients. States had various methods for monitoring participating 
providers. For example, North Carolina compiled quality of care 
indicators from claims data and annual chart reviews and shared these 
indicators with all providers in the state. State officials reported 
challenges to improving care coordination for children in Medicaid and 
CHIP. For example, most state representatives we spoke with said that 
because specialists are in shorter supply in rural areas, obtaining 
referrals to specialists was still an issue. Other challenges 
identified by states included ensuring timely payments to providers 
and adequate reimbursement for specialists. As of December 2010, only 
one state--North Carolina--had formally evaluated its initiative. 
These evaluations projected Medicaid cost savings from the initiative 
due to a reduction in the use of certain services, such as emergency 
room visits for enrolled patients. (See enclosure III for additional 
information on care coordination initiatives in the five selected 
states.) 

The two required summary reports that states provide annually to CMS 
are of limited use for monitoring the provision of services to 
children in Medicaid and CHIP due to reporting errors, missing 
information, and lack of detail. Our review of fiscal year 2008 CMS 
416 reports found that 12 states made reporting errors on their 
reports, and in 10 of these states errors were large enough to result 
in overstatement of the extent to which children received well-child 
checkups. For both the CMS 416 and the CHIP annual reports, we found 
missing information, such as states not reporting required information 
on the number of children in Medicaid referred for additional 
services, which resulted in gaps in information on children's access. 
Both annual reports lack the detail necessary to assess children's 
access to care by delivery model, that is, the information needed to 
monitor services provided to children in managed care versus services 
provided in fee-for-service systems. Further, although the CMS 416 
captures, for some states, information on the number of children 
referred to other providers for treatment services, it does not 
identify whether those children actually received the needed services. 
More detailed information could be helpful to CMS and others for 
identifying state Medicaid or CHIP programs for further review and 
monitoring. In 2010, HHS reported on the information available to 
monitor children's access to services in Medicaid and CHIP. In its 
report, HHS recognized that the information reported in CMS 416 and 
CHIP annual reports, and other data sources used for management of the 
Medicaid and CHIP programs, was not always accurate and complete. HHS 
committed to improving the quality of information available on 
children's access to care in these programs. CMS has efforts under way 
to improve state reporting on the CMS 416 and CHIP annual reports, 
including training CMS staff who work with states on reporting CMS 416 
information, convening a national workgroup that will provide input on 
improving technical assistance and guidance to states on reporting on 
EPSDT services, and plans to provide technical assistance to states on 
the CHIP annual report measures.[Footnote 16; Footnote 17] As of 
December 2010, these efforts did not include planning for separate 
reporting on the provision of services by managed care and fee-for-
service delivery models. 

Conclusions: 

Although some states are expanding initiatives to help improve 
children's access to care coordination services, almost one-quarter of 
families with Medicaid and CHIP children who needed specialty care 
reported problems accessing that care. Monitoring is important for 
ensuring access to specialty care for Medicaid and CHIP children, 
including the collection of information on whether needed specialty 
care services for which children have been referred were received. To 
appropriately inform oversight efforts and the public on the provision 
of services in the Medicaid and CHIP programs, accurate and complete 
reporting is needed. Ensuring the accuracy and completeness of 
information collected on the provision of services to children in 
Medicaid and CHIP has been a challenge for CMS despite federal 
requirements for annual reports from states and a long-standing CMS 
goal for states to routinely provide well-child checkups for eligible 
children. CMS's recent efforts are positive steps toward helping to 
ensure the usefulness of the information collected to better monitor 
the provision of services. However, information is lacking on whether 
those referred for treatment services ever received those services. 
Continued steps to improve the accuracy and completeness of state 
reports and to identify options for improving their usefulness are 
warranted. 

Recommendations: 

In light of the need for accurate and complete information on 
children's access to health services under Medicaid and CHIP, the 
requirement that states report information to CMS on certain aspects 
of their Medicaid and CHIP programs, and problems with accuracy and 
completeness in this state reporting, we recommend that the 
Administrator of CMS: 

* establish a plan, with goals and time frames, to review the accuracy 
and completeness of information reported on the CMS 416 and CHIP 
annual reports and ensure that identified problems are corrected, and: 

* work with states to identify additional improvements that could be 
made to the CMS 416 and CHIP annual reports, including options for 
reporting on the receipt of services separately for children in 
managed care and fee-for-service delivery models, while minimizing 
reporting burden, and for capturing information on the CMS 416 
relating to children's receipt of treatment services for which they 
are referred. 

Agency Comments: 

We provided a draft of this report to HHS for comment. Responding for 
HHS, CMS agreed with our recommendations. The full text of CMS's 
comments is reprinted in enclosure IV. CMS also provided technical 
comments, which we incorporated as appropriate. 

In its comments, CMS noted efforts it is planning or has under way 
that begin to address our recommendations that we believe are positive 
steps. These include working with states to improve EPSDT data 
reporting requirements, identifying options to improve the value of 
the CMS 416 and CHIP annual reports, and drafting regulatory guidance 
for states for consistent reporting of managed care encounter data. 
However, we note that some of CMS's efforts are toward improving data 
that are voluntarily reported by states, as opposed to improving data 
that are required, such as the CMS 416 and CHIP annual reports and 
their underlying data. CMS's ability to monitor children's access to 
services is dependent on consistent, reliable, complete, and 
sufficiently detailed data from each state. 

We are sending copies of this report to the Secretary of HHS and 
appropriate congressional committees. The report also is available at 
no charge on GAO's Web site at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions or need additional 
information, please contact me at (202) 512-7114 or iritanik@gao.gov. 
Contact points for our Offices of Congressional Relations and Public 
Affairs may be found on the last page of this report. GAO staff 
members who made key contributions to this report are listed in 
enclosure V. 

Signed by: 

Katherine Iritani: 
Acting Director, Health Care: 

Enclosures - 5: 

[End of section] 

Enclosure I: Medicaid and CHIP: Information on Children's Access to 
Care Coordination and Networks of Care, and on States' Reports to CMS 
on the Provision of Services: 

Briefing for staff of the Committee on Finance, United States Senate: 
Committee on Energy and Commerce, House of Representatives: 

Updated: 

Introduction: 

In 2008, more than 36 million children in the United States received 
health care coverage through Medicaid or the Children's Health 
Insurance Program (CHIP). 

* About 29.3 million low-income children received coverage through
Medicaid.[Footnote 18] 

* About 7.4 million received coverage through CHIP. 

Like all children, children in Medicaid and CHIP may have health care 
conditions that could warrant primary care providers' or specialists' 
care. 

A significant number of children in Medicaid and CHIP do not receive 
basic preventive care, which all state Medicaid and CHIP programs 
generally cover. 

* For example, in 2009 we estimated that 40 percent of children in
Medicaid and CHIP had not had a well-child checkup over a 2-year 
period.[Footnote 19] 

State Medicaid and CHIP programs and other payers have begun
implementing initiatives to improve care coordination for children and 
provide access to networks of care.[Footnote 20] 

* Care coordination can help children access a network of care (i.e., 
a set of providers who are available to help address a child's primary 
and specialty health care needs). 

The Centers for Medicare & Medicaid Services (CMS) oversees state 
Medicaid and CHIP programs at the federal level and collects annual 
reports. States are required under federal law: 

*	to annually report to CMS on the provision of a range of preventive,
diagnostic, and treatment services for eligible children, known as
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) 
services,[Footnote 21] and; 

* to assess the operations of their CHIP programs and report to CMS on 
the results of those assessments annually. 

The Children's Health Insurance Program Reauthorization Act of 2009 
(CHIPRA) required GAO to study and report on certain aspects of the 
access of children in Medicaid and CHIP to primary and specialty 
services.[Footnote 22] This briefing provides information on: 

1. The extent to which children in Medicaid and CHIP receive care 
coordination and have access to networks of care. 
	
2.	How selected states are coordinating care for children in Medicaid 
and CHIP. 

3. The extent to which the required state reports collected by CMS 
provide information on the provision of services to children in 
Medicaid and CHIP. 

Scope and Methodology: 1: Care Coordination and Access to Networks of 
Care:	 

To examine the extent to which children in Medicaid and CHIP receive 
care coordination and have access to networks of care, we analyzed two 
nationally representative surveys administered by Department of Health 
and Human Services (HHS) agencies. 

*	The National Survey of Children's Health (NSCH), administered by the 
National Center for Health Statistics (2007 survey, most recent 
available). The NSCH collected data from 91,000 parents and guardians 
on health questions, including questions related to care coordination 
for their children. For Medicaid- and CHIP-covered children 17 years 
of age and younger, we examined children's need for care coordination 
services and whether their families reported having a problem 
accessing services. The NSCH only includes information for children 17 
years of age and younger. 

*	The Medical Expenditure Panel Survey (MEPS), administered by the 
Agency for Health Care Research and Quality (2005, 2006, and 2007 
surveys).[Footnote 23] The MEPS collected data on more than 30,000 
persons, including information from families, individuals, and their 
medical providers, on use of, and access to, health services. For
Medicaid- and CHIP-covered children 17 years of age and younger, we 
assessed access to networks of care by examining questions related to 
children's need for care, tests, and treatment and for access to 
needed specialists, and whether their families reported having a problem
accessing needed services or specialists. 

- For consistency with the NSCH, we analyzed MEPS survey results for 
children 17 years of age and younger. 

- We also compared Medicaid- and CHIP-covered children to uninsured 
and privately insured children. 

Scope and Methodology: 2: State Care Coordination Initiatives: 

To examine how selected states are coordinating care for Medicaid- and 
CHIP-covered children, we obtained information on initiatives in five 
selected states: Colorado, Illinois, New York, North Carolina, and 
Oklahoma. 

*	The states in our nongeneralizable sample were identified in 
literature and by experts as having implemented initiatives to improve 
care coordination for Medicaid- and CHIP-covered children. 

* The five states were selected from 21 that experts identified to 
provide (1) geographic diversity, (2) a mix of small and large 
Medicaid and CHIP programs, and (3) a mix of programs with and without 
a large proportion of children enrolled in managed care.[Footnote 24] 

Scope and Methodology: 3: Information States Report to CMS:	 

To examine the extent to which state reports collected by CMS provide 
information on the provision of services to Medicaid- and CHIP-covered 
children, we assessed federal fiscal year 2008 information from the 
two key summary reports required by federal law:[Footnote 25] 

* CMS 416 reports: required for state Medicaid programs, CMS 416 
reports are due April 1 after the end of the federal fiscal year. 

*	State CHIP annual reports: required for state CHIP programs, CHIP 
annual reports are due January 1 after the end of each federal fiscal 
year. 

We conducted this performance audit from September 2009 to April 2011 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

Background: Medicaid: 

States operate their Medicaid programs within broad federal 
requirements. 

*	State Medicaid programs are generally required to cover EPSDT 
services. 

*	States may operate their Medicaid programs through various models—
for example, they may pay providers directly for services (fee-for-
service) or they may contract with managed care organizations to 
provide benefits. 

Background:	CHIP:	 

As for Medicaid, states operate their CHIP programs within broad 
federal requirements. 

* In 2010, states administered their CHIP programs in three ways: 
- 7 states administered CHIP as an expansion of their Medicaid 
programs,[Footnote 26] 
- 18 states administered separate, stand-alone CHIP programs, and
- 26 states had a combined program, with both a Medicaid expansion and 
a separate CHIP program. 

States may operate their CHIP programs through a fee-for-service 
delivery model, or they may contract with managed care organizations 
to provide benefits. 

States are required to cover certain benefits for CHIP-covered 
children: 

*	For example, CHIP-covered children covered under Medicaid expansion 
programs must receive the same benefits, including EPSDT benefits, as 
Medicaid-covered children. 

Background: State Medicaid Reports: 

Medicaid: Since 1990, CMS has required states to submit CMS 416 
reports to the agency that contain information on the provision of 
EPSDT services, such as well-child checkups, to children enrolled in 
Medicaid. 

*	States collect information from fee-for-service providers and 
managed care plans to complete the reports. 
-	As we have reported, states face challenges in collecting complete 
and accurate information for CMS 416 reports, particularly from 
managed care plans that are not reimbursed on the basis of providing 
individual services.[Footnote 27] 

CMS uses these reports to monitor states' progress in meeting the 
agency's annual goal that states provide a well-child checkup to at 
least 80 percent of children eligible to receive one.[Footnote 28] CMS 
makes the state reports available on the agency's Web site. 

Many states have reported using the CMS 416 to monitor Medicaid 
children's utilization of preventive services.[Footnote 29] 

Background: State CHIP Reports: 

CHIP: Since 2002, CMS has required states to submit CHIP annual 
reports. Since 2003, CMS has asked that these reports include 
information on four performance measures used to assess states' 
provision of services to children in CHIP:	 

* receipt of well-child visits during the first 15 months of life;	 

* receipt of well-child visits in the third, fourth, fifth, and sixth 
years of life;	 

* use of appropriate medications in children with asthma; and;	 

* children's access to primary care providers.	 

States have flexibility in the data they use to report these measures; 
for example, they may use claims data, a mixture of claims data and 
medical records, or survey data.	 

CMS uses these reports to produce and publish a summary of state CHIP 
programs and also makes them available on CMS's Web site.	 

1: Care Coordination and Networks of Care: Overview of Finding 1: 

Two nationally representative surveys from 2007 suggest that many 
Medicaid- and CHIP-covered children needing care coordination did not 
receive it, and many needing access to networks of care had difficulty 
accessing the needed services.[Footnote 30] 

* Care Coordination: 
-	NSCH data from 2007 suggest that 45 percent of Medicaid- and CHIP-
covered children needed care coordination, and 37 percent of those did 
not receive it. 

* Access to Networks of Care: 
-	Access to care, tests, or treatment. MEPS data from 2007 suggest 
that 34 percent of Medicaid- and CHIP-covered children needed care, 
tests, or treatments, and 12 percent of those had problems accessing 
the needed services.
-	Access to specialists MEPS data from 2007 suggest that 15 percent of 
Medicaid- and CHIP-covered children needed to see specialists, and 24 
percent of those had problems seeing specialists.[Footnote 31] 

1: Care Coordination and Networks of Care: NSCH Care Coordination Data: 

NSCH data from 2007 suggest that 45 percent of Medicaid- and CHIP-
covered children needed care coordination, and 37 percent of those 
children did not receive it. 

*	The NSCH measures care coordination for children who received two or 
more services in the prior 12 months. For these children, the NSCH 
examines survey responses related to getting help coordinating care 
when needed, satisfaction with communication between health care 
providers, and satisfaction with communication between health care 
providers and other entities (such as schools).[Footnote 32] 

*	On the basis of NSCH families' reports in the 2007 survey, 45 
percent of Medicaid- and CHIP-covered children 17 years of age and 
younger needed care coordination services. Projected nationally, this 
represents an estimated 9.4 million children.[Footnote 32] 

*	Of those Medicaid- and CHIP-covered children 17 years of age and 
younger whose families reported needing care coordination services, 37 
percent did not receive the needed services. Projected nationally, 
this represents an estimated 3.5 million children.[Footnote 33] 

1: Care Coordination and Networks of Care: MEPS Data on Needed Care, 
Tests, or Treatment:	 

MEPS data from 2007 suggest that 34 percent of Medicaid- and CHIP-
covered children needed care, tests, or treatments, and 12 percent of 
those had problems accessing the needed services. 

*	The MEPS asks families if their child needed any care, tests, or 
treatment in the last 12 months. The MEPS also asks families how much 
of a problem, if any, it was to get the care, tests, or treatments the 
family or a doctor believed were necessary for the child. On the basis 
of MEPS families' reports in the 2007 survey, 34 percent of Medicaid- 
and CHIP-covered children 17 years of age and younger needed care, 
tests, or treatments. Projected nationally, this represents an 
estimated 7.3 million children. 

*	Of those Medicaid- and CHIP-covered children 17 years of age and 
younger whose families reported that they needed care, tests, or 
treatments, 12 percent of families reported problems accessing the 
needed services. Projected nationally, this represents an estimated 
844,000 children. 

MEPS data from 2005 and 2006 concerning access to networks of care are 
consistent with the data from 2007 reported here. 

1: Care Coordination and Networks of Care: MEPS Data on Access to 
Specialists: 

MEPS data from 2007 suggest that 15 percent of Medicaid- and CHIP-
covered children needed to see specialists, and 24 percent of those 
had problems seeing specialists. 

*	The MEPS asks families if their child needed to see a specialist in 
the past 12 months and how much of a problem, if any, it was to see a 
specialist that the child needed to see. 

*	On the basis of MEPS families' reports in the 2007 survey, 15 
percent of Medicaid- and CHIP-covered children 17 years of age and 
younger needed to see a specialist. Projected nationally, this 
represents an estimated 3.2 million children. 

*	Of those Medicaid- and CHIP-covered children 17 years of age and 
younger whose families reported that they needed to see a specialist, 
24 percent of families reported problems accessing the specialist. 
[Footnote 35] Projected nationally, this represents an estimated 
769,000 children. 

MEPS data from 2005 and 2006 concerning access to specialists are 
consistent with the data from 2007 reported here. 

1: Care Coordination and Networks of Care: 

Comparing Medicaid-and CHIP-covered children with uninsured and 
privately insured children, MEPS data from 2007 show that a greater 
proportion of Medicaid-and CHIP-covered children and uninsured 
children experienced problems accessing needed care and needed 
specialists than privately insured children. 

Figure: Reported a problem accessing needed care, tests, or treatment, 
2007: 

[Refer to PDF for image: vertical bar graph] 

Medicaid/CHIP: 12%; 
Uninsured: 16%; 
Private[A]: 6%. 

Source: GAO analysis of 2007 MEPS data. 

[A] There is a significant difference at the 95 percent confidence 
level for this insurance type when compared to other insurance types. 

[End of figure] 

Figure: Reported a problem accessing needed specialists, 2007: 
											
Medicaid/CHIP[A]: 24%; 
Uninsured[B]: 29%; 
Private: 18%. 

Source: GAO analysis of 2007 MEPS data. 				
											
[A] The confidence interval for this estimate is plus or minus 6 
percent at the 95 percent confidence level. 

[B] The confidence interval for this estimate is plus or minus 9 
percent at the 95 percent confidence level. 

[End of figure] 

2: Care Coordination Initiatives: Overview of Finding 2: 

Initiatives in the five selected states were designed to improve care 
coordination by assigning children to medical homes and increasing 
payments to providers. 

*	Care coordination initiatives in the states we examined varied in 
the populations covered and in the delivery model, but shared common 
elements: 
-	States had processes for assigning children to a medical home. 
[Footnote 36] States provided enhanced payments to providers who were 
approved to participate in the states' care coordination initiatives 
and provide services. 
-	States provided support to providers and monitored their initiatives. 

*	States identified challenges to improving care coordination, and 
only one of the five states has conducted a formal, independent 
evaluation of its program. 

2: Care Coordination Initiatives: Characteristics of State Initiatives: 

Table: Care coordination initiatives	in the five states varied in the 
populations	covered and in the delivery	models	used. 

State Initiative: Colorado-—Medical Home Initiative;	
Year started: 2007;	
Population covered:	Medicaid: Children;	
Population covered: CHIP: Children;	
Delivery model: Medicaid: FFS;	
Delivery model: CHIP: MC. 

State Initiative: Illinois-—Health Connect; 	
Year started: 2007;	
Population covered:	Medicaid: Children and adults; 	
Population covered: CHIP: Children; 	
Delivery model: Medicaid: FFS (PCCM);	
Delivery model: CHIP: FFS (PCCM). 

State Initiative: New York—-Patient Centered Medical Home; 	
Year started: 2009; 	
Population covered:	Medicaid: 
Population covered: CHIP: [Empty]; 
Delivery model: Medicaid: FFS and MC; 
Delivery model: CHIP: [Empty]. 

State Initiative: North Carolina-—Community Care of North Carolina; 	
Year started: 1998; 	
Population covered:	Medicaid: Children and adults; 
Population covered: CHIP: Children[A]; 
Delivery model: Medicaid: FFS (PCCM); 	
Delivery model: CHIP: FFS (PCCM)[A]. 

State Initiative: Oklahoma—-Sooner Care Choice; 	
Year started: 2009; 	
Population covered:	Medicaid: Children and adults; 	
Population covered: CHIP: Children; 	
Delivery model: Medicaid: FFS (PCCM);	
Delivery model: CHIP: FFS (PCCM). 

Source: GAO analysis.	 

Legend: 
FFS = fee-for-service; 
MC = managed care; 
PCCM care	= primary care case coordination payments	management.		 

[A] In October 2009, North Carolina temporarily	discontinued for CHIP-
covered	children. 

[End of table] 

2: Care Coordination Initiatives: Assigning Children to Medical Homes: 

All five states' initiatives have processes for assigning children to 
a medical home. 

Examples of these processes included the following: 

*	In Illinois, once a potential enrollee becomes eligible for the 
initiative, a contractor employed by the state has 5 days to issue an 
initial enrollment packet to the eligible individual or family. Within 
60 days of receiving this packet, the potential enrollee must choose a 
primary care provider as a medical home, or be automatically assigned 
to one. 

*	In North Carolina, it is mandatory for infants eligible for Medicaid 
and children ages 1 through 18 to be enrolled in the state's 
initiative. Once they are enrolled, the local county department of 
social services assists each family in choosing a provider to be the 
child's medical home. 

2: Care Coordination Initiatives: Methods to Approve Providers for 
Participation:	 

States used three types of methods to approve providers for 
participation: 

*	Illinois and North Carolina used provider agreements as a condition 
of approval for providers. Providers agreeing to meet certain basic 
standards could participate in the initiative. For example, in 
Illinois, participating providers agreed to provide preventive 
services and to coordinate care for specialty services. 

*	In Oklahoma and Colorado, providers were approved by the state after 
the state conducted a review and determined that the providers met 
certain standards, such as being available 24 hours a day, 7 days a 
week, by expanding their normal office hours or arranging for an 
alternate provider. 

*	New York required its providers to be reviewed and approved as a 
medical home by a nationally recognized organization—the National 
Committee for Quality Assurance—in order to participate in the state's 
medical home initiative. 

In addition, two of the states (Oklahoma and New York) used a tiered 
approach for approval, where providers were approved to a specific 
tier based on their ability to provide designated levels of care 
coordination services through tools they used in their practices. 

2: Care Coordination Initiatives: Standards Approved Providers Must 
Meet: 

The standards that participating providers were required to meet 
varied among states, but included requirements such as:	 

* having a system in place for patients to contact their provider 24 
hours a day, 7 days a week (Colorado, Illinois, North Carolina, 
Oklahoma);	 

*	tracking referrals to other physicians or identifying the number of 
patients with certain chronic conditions (Illinois, New York);	 

*	designing care management plans that can include items such as the 
patient's condition, a list of medications and instructions for use, a 
list of symptoms for which they need to contact their providers, and 
patient communication preference (Illinois, New York);	 

*	having cultural competency, for example, providing cultural training 
to staff in the practice (Colorado);	 

*	implementing evidence-based guidelines for certain conditions (New 
York); and;	 

*	submitting quality improvement plans or performance reports 
(Colorado, New York, North Carolina).	 

2: Care Coordination Initiatives:	Types of Enhanced Payments to 
Providers: 

States used one or more of the following three approaches to provide 
enhanced payments for the care coordination services provided through 
medical homes:	 

* per member per month payments to providers for each patient	
	covered by the initiative who was enrolled with the provider;	
	
*	increased payment rates for the provision of certain services, such 
as EPSDT services; and;	 

*	performance-based bonuses or incentive payments to providers who 
achieved goals such as increasing well-child screenings to a certain 
percentage of children.	 

	In addition, in the two states with tiered approvals (Oklahoma and 
New York), larger payments were made to providers approved at the 
higher levels.	 

2: Care Coordination Initiatives: Methods and Amounts for Enhanced 
Payments: 

Table: 

State: Colorado; 
Enhanced payment method: Per member per month: [Empty]; 
Enhanced payment method: increased payment rate: [Empty]; 
Enhanced payment method: Performance bonus or incentive: [Check]; 
Amount of enhanced payment: For Medicaid, pay for performance includes 
$10 per well-child visit for ages under 5 and $40 for age 5 and older, 
and for CHIP, up to $21 per child. 

State: Illinois; 
Enhanced payment method: Per member per month: [Check]; 
Enhanced payment method: increased payment rate: [Check]; 
Enhanced payment method: Performance bonus or incentive: [Check]; 
Amount of enhanced payment: Providers are paid a case management fee 
of $2 per child (under age 21) per month and can receive increased 
payments by billing separately for services that are normally bundled. 
Providers can also receive up to $25 per patient bonus payments for 
meeting or exceeding certain quality measures. 

State: New York; 
Enhanced payment method: Per member per month: [Check]; 
Enhanced payment method: increased payment rate: [Check]; 
Enhanced payment method: Performance bonus or incentive: [Empty]; 
Amount of enhanced payment: Providers in the state's fee-for-service 
program can receive from about $5 to $21 (based on tier) in extra 
payments for certain types of office visits, and providers in managed 
care can receive $2 to $6 extra per member per month. 

State: North Carolina; 
Enhanced payment method: Per member per month: [Check]; 
Enhanced payment method: increased payment rate: [Empty]; 
Enhanced payment method: Performance bonus or incentive: [Empty]; 
Amount of enhanced payment: Providers can receive about $5 per member 
per month for patients who are blind or disabled and $2.50 for other 
patients. 

State: Oklahoma; 
Enhanced payment method: Per member per month: [Check]; 
Enhanced payment method: increased payment rate: 
Enhanced payment method: Performance bonus or incentive: [Check]; 
Amount of enhanced payment: Providers can receive per member per month 
payments of about $3.50 to $7.50 based on certification tier and 
patient type. In addition, bonus payments are given based on 
performance goals set by the practice and on the practice's meeting 
national quality indicators for certain childhood screenings. 

Source: GAO analysis	of documentation	from five	selected states.	 

[End of table] 

2: Care Coordination Initiatives: State Activities to Support 
Providers and Monitor Initiatives: 
	
States had several processes to support participating providers in 
providing care coordination services. 

* Four states had toll-free numbers providers could call to find 
specialists who were accepting Medicaid- or CHIP-covered patients. 

* Four states had staff who could come to the offices of participating 
providers to provide support or answer questions related to the 
program. 

States also had various methods for monitoring participating providers. 

* For example, North Carolina compiled quality of care indicators from 
claims data and annual chart reviews and shared these indicators with 
all providers in the state. These indicators included: 
-	number of patients admitted to emergency rooms,
-	percentage of preventable readmissions to the hospital,
-	number of administered diabetes examinations, and, 
-	number of asthma-related emergency room visits. 

State officials reported that sharing the quality of care indicators 
has instilled competition among the providers to improve their 
performance. 

2: Care Coordination Initiatives: Challenges and Formal Evaluations:	 

States identified some challenges to improving care coordination for 
Medicaid- and CHIP-covered children. For example: 

* Most state representatives we spoke with said that obtaining 
referrals to specialists was still an issue in rural areas. Because 
specialists for the most part are in shorter supply in rural areas, it 
was hard for some providers to find specialists for their patients. 

* Colorado found that some providers had not yet joined the initiative 
because they believed the compensation for Medicaid- and CHIP-covered 
patients was too low. Other challenges identified by states included 
ensuring timely payments to providers and adequate reimbursement for 
specialists. 

Only one state had conducted an independent formal evaluation of its 
care coordination initiative: 

* North Carolina hired a contractor to evaluate the effect of its 
initiative. The evaluation compared the actual cost for participants 
in the initiative with an estimated cost for participants had they not 
been enrolled in the initiative. The contractor estimated that the 
initiative saved the state $190 million in 2009 by reducing the cost 
of certain services, including inpatient, outpatient, and emergency 
room services. 

3: Information States Report to CMS: Overview of Finding 3: 

Information states report to CMS has weaknesses that limit its 
usefulness for measuring and monitoring children's access to care. 

* Reporting errors: States report data that fall outside of 
permissible ranges or that are contrary to instructions provided by 
CMS (CMS 416). 

* Missing information: States do not report certain categories of data 
(CMS 416 and CHIP annual report). 

* Lack of detail: States report summary information that lacks detail 
on services children receive by delivery model (CMS 416 and CHIP 
annual report) and whether children actually receive the services they 
need (CMS 416). 

Internal control standards specify that agencies should collect 
information to monitor program objectives in order to determine 
whether the agencies are meeting their strategic goals.[Footnote 37] 
	
3: Information States Report to CMS: Reporting Errors: 

Several states made reporting errors on their CMS 416 reports in 
fiscal year 2008, resulting in overstatement of the extent to which 
children received well-child checkups. 

*	States are required to report the percentage of eligible children 
who received at least one well-child checkup, known as the participant 
ratio. 
-	Valid participant ratios cannot be larger than 100, as this would 
mean more children received a checkup than were eligible to receive one.
-	In fiscal year 2008, 12 states reported participant ratios over 100 
for at least one age group.
-	Ten of the 12 states had errors large enough to affect their overall 
participant ratios, with the amount of overstatement ranging from 1 to 
14 percent. 

* Even with overstated overall participant ratios, few states met or 
exceeded CMS's 80 percent goal. In fiscal year 2008, only 2 states met 
or exceeded CMS's goal, and the nationwide participant ratio was 63 
percent. 

3: Information States Report to CMS:	Missing Information: 

Several states provided reports with missing information in fiscal 
year 2008, which resulted in gaps in information on children's access 
to care. 

* On the CMS 416, states are required to report the number of children 
who are referred for additional services as a result of health 
problems identified during well-child checkups. 
-	In fiscal year 2008, 42 states reported information on referrals 
made, and 9 states did not report any information on the number of 
referrals made. 

On the CHIP annual report, CMS specifies that states are required to 
report on the four performance measures only to the extent that 
information is available to the state. 

* In fiscal year 2008, 18 states did not report all measures to CMS-10 
states reported on three measures, 6 states reported on two measures, 
and 2 states reported on one measure. 

3: Information States Report to CMS: Lack of Detail: 

CMS 416 and CHIP annual reports lack detail necessary to assess access 
by delivery model. Specifically, these reports do not distinguish 
between children in fee-for-service and those in managed care delivery 
models, and so potential access problems unique to a particular 
delivery model cannot be assessed.[Footnote 38] 

* Different delivery models may provide different incentives that have 
unintended, negative effects. For example, in managed care models, 
when states provide a set payment amount in advance to provide 
services to beneficiaries, it may create an incentive to underserve or 
deny access to needed care. 
-	For example, in a 2010 report examining children's access to dental 
services, we compared CMS 416 information from states using only fee-
for-service with CMS 416 information from states using predominately 
managed care. This comparison suggested that children in managed care 
received fewer dental services, although comprehensive and reliable 
information to more thoroughly examine this difference was not 
available.[Footnote 39] 

* In addition, although the CMS 416 captures, for some states, 
information on the number of children referred to other providers for 
treatment services, it does not identify whether those children 
actually received the needed services. 

3: Information States Report to CMS: HHS Recognizes Weaknesses: 

HHS has recognized the weaknesses in available Medicaid and CHIP 
information. 

*	In September 2010, HHS published a report in which it reviewed 
available information on the quality of care for children in Medicaid 
and CHIP, including information on children's access to care.[Footnote 
40] 

HHS concluded that: 

* wide variation exists in the accuracy and completeness of state 
information on the quality of care received by children enrolled in 
Medicaid and CHIP, and; 

*	Medicaid and CHIP information submitted to CMS by the states, 
including the CMS 416, CHIP annual report, and other information used 
to manage the programs, is not sufficiently complete, accurate, or 
timely to meet objectives of evaluating program performance or the 
quality of care beneficiaries receive. 

3: Information States Report to CMS: CMS Efforts to Improve Medicaid 
and CHIP Reporting: 

CMS officials reported that they have recently taken positive steps to 
improve Medicaid and CHIP data reporting. 

*	In October 2010, CMS provided training for CMS EPSDT coordinators 
and other staff who work with states on reporting information on the 
CMS 416. 

*	In December 2010, CMS convened the first meeting of the National 
EPSDT Workgroup, which will provide input on reporting on EPSDT 
services and ways to improve technical assistance and guidance to 
states, among other items. 

*	CMS has also formed an internal work group to improve the Medicaid 
Statistical Information System (MSIS), which collects data from states 
on enrollment and service utilization.[Footnote 41] These data could 
be useful to CMS and others to examine provision of services for 
children. 

Starting in 2011, CMS will provide technical assistance to states on 
three of the four performance measures on the CHIP annual report with 
the goal of improving consistent collection and uniform reporting of 
these measures in conjunction with a CHIPRA-mandated quality measures 
initiative.[Footnote 42] 

Starting in 2013 for CHIP annual reports, CMS will require states to 
report additional information collected through satisfaction surveys 
of beneficiaries, including information on access to primary and 
specialty services, access to networks of care, and care coordination, 
as required under federal law. 

However, CMS officials have indicated that they do not plan to require 
states to report on the provision of services to Medicaid- and CHIP-
covered children by delivery model; that is, to report information on 
children in managed care separately from information on children in 
fee-for-service. Officials said that reporting separately by delivery 
model would be an additional burden on the states. 

As a result, it will still not be possible to assess access to care 
for Medicaid-and CHIP-covered children by delivery model. 

[End of Enclosure I] 

Enclosure II: Scope and Methodology for NSCH and MEPS Analyses: 

To examine the extent to which Medicaid-and CHIP-covered children 
receive care coordination and have access to networks of care, we 
analyzed two nationally representative surveys conducted by the 
Department of Health and Human Services (HHS). We analyzed the 
National Survey of Children's Health (NSCH) to examine the extent to 
which Medicaid-and CHIP-covered children receive care coordination. We 
examined the Medical Expenditure Panel Survey (MEPS) to examine the 
extent to which Medicaid-and CHIP-covered children have access to 
networks of care. 

To assess the reliability of the NSCH and MEPS data, we spoke with 
knowledgeable agency officials and reviewed related documentation and 
compared our results to published data. We determined that the NSCH 
and MEPS data were sufficiently reliable for the purposes of our 
engagement. 

National Survey of Children's Health (NSCH): 

The NSCH is a nationally representative survey conducted by HHS's 
Centers for Disease Control and Prevention (CDC). The NSCH includes a 
variety of health indicators developed by the Maternal and Child 
Health Bureau in collaboration with CDC's National Center for Health 
Statistics and a national technical expert panel.[Footnote 43] Our 
analysis was based on the 2007 NSCH, the most recent data available. 
Data in the NSCH are compiled through a random-digit-dialed sample of 
households with children 17 years of age or younger from each of the 
50 states and the District of Columbia.[Footnote 44] One child was 
randomly selected from all children in each identified household to be 
the subject of the survey, and the respondent was a parent or guardian 
who knew about the child's health and health care. We analyzed NSCH's 
measure of effective care coordination to estimate the extent to which 
Medicaid-and CHIP-covered children 17 years of age and younger needed 
care coordination and the extent to which those needing care 
coordination received it. 

The NSCH care coordination measure classifies children as needing care 
coordination if their parent or guardian responded that: 

1. during the prior 12 months the child used services in two or more 
of the following categories: preventive medical, preventive dental, 
mental health care, or specialist services; and: 

2. the family received help coordinating the child's care among the 
different doctors or services used, or could have used extra help 
coordinating the child's care among the different providers and 
services. 

The NSCH measure classifies children as receiving effective care 
coordination if they needed care coordination and their parent or 
guardian responded that:[Footnote 45] 

1. they received help coordinating care, did not need extra help 
coordinating, or usually received the extra help in coordinating their 
child's care when extra help was needed; and: 

2. they were very satisfied with the doctor's communication with other 
health care providers, when such communication was needed; and: 

3. they were very satisfied with the doctor's communication with other 
entities (such as schools, child care providers, and special 
educational programs), when such communication was needed. 

Medical Expenditure Panel Survey: 

The MEPS is a nationally representative survey administered by HHS's 
Agency for Healthcare Research and Quality (AHRQ) that provides 
information on children's use of, and access to, health services. Our 
analysis of MEPS was based on data from the 2005, 2006, and 2007 
surveys.[Footnote 46] We obtained data from the MEPS household 
component. The household component of MEPS collects data from a sample 
of families and individuals in selected communities across the United 
States. The sample is drawn from a nationally representative subsample 
of households that participated in the prior year's National Health 
Interview Survey (NHIS), a survey conducted by the National Center for 
Health Statistics at CDC. The MEPS household survey uses several 
rounds of interviewing covering 2 full calendar years. The MEPS is 
continuously fielded; each year a new sample of households is 
introduced into the study. The MEPS collects information for each 
person in the household based on information provided by one adult 
member of the household. This information includes demographic 
characteristics, self-reported health conditions, reasons for medical 
visits, use of medical services including preventive services, and 
health insurance coverage. 

We analyzed data for several different MEPS questions as proxies for 
whether children 17 years of age and younger had access to networks of 
care, specifically: 

* In the last 12 months, did you or a doctor believe [your child] 
needed any care, tests, or treatment? 

* If yes, in the last 12 months, how much of a problem, if any, was it 
to get the care, tests, or treatments you or a doctor believed 
necessary [for your child]? 

* In the last 12 months, did you or a doctor think [your child] needed 
to see a specialist? 

* If yes, in the last 12 months, how much of a problem, if any, was it 
to see a specialist that [your child] needed to see? 

We analyzed MEPS questions for children 17 years of age and younger to 
be consistent with the ages analyzed in the NSCH. 

[End of Enclosure II] 

Enclosure III: Summary of Care Coordination Initiatives in Five 
Selected States: 

To examine how selected states are coordinating care for Medicaid- and 
CHIP-covered children, we reviewed literature and spoke with experts 
and stakeholders about state efforts to improve care coordination. We 
identified 21 states that were developing or had implemented care 
coordination programs for Medicaid- and CHIP-covered children. We 
selected 5 of the 21 states for a more detailed review: Colorado, 
Illinois, New York, North Carolina, and Oklahoma. This judgmental 
sample was chosen to (1) include geographic diversity, (2) represent a 
mix of small and large Medicaid and CHIP programs, and (3) include 
states with a large share of Medicaid- and CHIP-covered children 
enrolled in managed care, as well as states with few or no children 
enrolled in managed care. In each state, we interviewed state 
officials and obtained information about the state care coordination 
initiative. We also interviewed officials from other groups involved 
in the state initiatives, such as physician associations and child 
advocacy groups. 

All five state initiatives were designed to improve care coordination 
by assigning children to medical homes and increasing payments to 
providers approved to participate in the initiative. Each state 
implemented its own version of a medical home with varying 
requirements for the care coordination services provided through the 
medical home. Tables 1 through 5 provide an overview and a description 
of some key characteristics about each state’s care coordination 
initiative. Specifically, for each state we provide information on the 
populations covered, provider participation requirements, provider 
payment methods, the type of state monitoring and support of 
providers, and the findings of any formal evaluations.[Footnote 47] 
The following tables provide information on similarities and 
differences across the five states’ initiatives. For example, while 
three methods were used for paying providers, the extent to which they 
were used varied across the states. The three payment methods are (1) 
per member per month payments, where providers receive a nominal 
monthly payment for each patient covered by the initiative and 
enrolled with the provider; (2) increased payment rates for certain 
services, such as well-child visits, provided to patients enrolled in 
the initiative; and (3) performance-based bonus payments or incentive 
payments to providers who meet state-established quality goals. 

Table 1: Description of Colorado’s Care Coordination Initiative, 
Colorado Medical Homes for Children: 

Initiative overview: 
Colorado started its initiative in 2007 to increase Medicaid- and CHIP-
covered children’s access to a medical home. In addition, Colorado 
uses the initiative to ensure that Medicaid children receive Early and 
Periodic Screening, Diagnostic and Treatment (EPSDT) services.
* In 2009, 236,000 Medicaid-covered and 67,000 CHIP-covered children 
participated in the program. Adults are not included in the program.
* Medicaid-covered children receive care through a fee-for-service 
delivery model, and CHIP-covered children receive care through a 
managed care delivery model.
* Primary care and specialty care providers can participate in the 
initiative once they are approved as a medical home. 

Provider participation requirements: 
Providers are approved to participate in the state’s medical home 
initiative by completing several steps. For example, providers must: 
* complete a Medical Home Index, which rates providers in areas such 
as cultural competencies, management of chronic conditions, 
preparation of a care plan that involves family members, and 
coordination with community agencies and schools as appropriate.
* submit a quality improvement plan.
* meet or be working toward meeting the state’s medical home 
standards, such as being available to patients 24 hours a day, 7 days 
a week; being culturally competent; and respecting the role of the 
family in a patient’s health care. 

Provider payment: 
Colorado providers participating in the initiative receive a 
performance payment for providing well-child visits. The state has 
different rates for Medicaid and CHIP.
* For Medicaid, providers receive an additional $10 per well-child 
visit for children under the age of 5, and $40 per well-child visit 
for children 5 and over. 
* For CHIP, primary care and obstetrics and gynecology providers 
receive up to an additional $21 for well-child visits. 

Monitoring, support, and evaluation: 
Colorado uses various methods to monitor and support providers.
* State officials visit providers who have applied to become a medical 
home to assess their capacity to function as a medical home.
* The state helps providers participating in the program refer 
patients to other providers by compiling, verifying, and sharing lists 
of providers who are eligible and participating in Medicaid and CHIP.
* The state helps providers become medical homes by paying a nonprofit 
health advocacy group to train providers in medical home standards and 
to inform them of incentive payments.[A] 

Although the state has not conducted a formal (external) evaluation of 
its initiative, it has, in collaboration with a nonprofit 
organization, compared services and outcomes of children enrolled in 
medical homes with children not enrolled in medical homes. The study 
found that children in medical homes had lower emergency room 
admissions and more well-child visits than children not in medical homes
Source: GAO analysis of state data. 

[A] In addition to funds and support from the state, Colorado’s 
providers also receive assistance from a nonprofit organization that 
supports practices that are becoming medical homes. 

[End of table] 

Table 2: Description of Illinois’s Care Coordination Initiative, 
Illinois Health Connect: 

Initiative overview: 
Illinois started its initiative in 2007 to establish a medical home 
and care coordination services for Medicaid and CHIP beneficiaries not 
enrolled in a Medicaid managed care plan. It is available to 
beneficiaries statewide.
* Illinois’s initiative is available to Medicaid- and CHIP-covered 
children. The initiative is also available to adults with Medicaid 
coverage.
* As of June 2009, about 1 million Medicaid- and CHIP-covered children 
were enrolled with providers participating in the state’s initiative.
* Care is delivered through a fee-for-service delivery model.
* Only primary care providers can participate in the program. 

Provider participation requirements: 
Primary care physicians are approved to participate in the state’s 
medical home initiative by signing an agreement with the state to meet 
certain care coordination standards. For example, providers agree to: 
* maintain routine, urgent, and as-needed appointment standards, 
including:
- routine preventive care available within 5 weeks of the date 
request, including within 2 weeks of the date request for infants less 
than 6 months;
- urgent care appointments for those not determined to be emergency 
should be provided within 24 hours;
- appointments for enrollee problems or complaints not deemed serious 
available within 3 weeks of the date of request;
- initial prenatal appointments without expressed problems: 1st 
trimester within 2 weeks, 2nd trimester within 1 week, 3rd trimester 
within 3 days; and; 
- upon notification of a hospitalization or emergency room visit; 
follow-up appointment available within 7 days of discharge from the 
hospital.
* maintain hospital admitting and/or delivery privileges or make 
arrangements for such privileges, and; 
* establish a care plan for individuals with chronic diseases that 
includes a list of medicines the patient is taking with dosages and 
when to take them, and a list of symptoms so patients know when to 
contact their provider. 

Provider payment: 
Illinois providers participating in the initiative are paid in three 
ways.[A] They receive: 
* a $2 per member per month payment for each child under the age of 21 
for whom the provider serves as the medical home;[B] 
* enhanced reimbursement rates for a number of selected office-based 
services; and; 
* bonus payments when they meet or exceed certain quality goals or 
outcomes. 

Monitoring, support, and evaluation: 
The state works in conjunction with a contractor that administers the 
day-to-day operations of the initiative to monitor and support 
providers that participate in the initiative. For example, the state: 
* 
monitors practices by conducting routine visits to providers’ offices, 
as well as visits to investigate complaints received from patients and 
other providers;
* monitors the frequency with which beneficiaries switch providers and 
the reasons cited for switching;
* recently identified specific clinical areas that it will monitor 
using claims data, such as asthma management, diabetes management, 
immunizations, and developmental screenings;
* monitors the availability of providers on a statewide, regional, 
county, city, and zip code level; and; 
* established an electronic data portal to support improvements and 
care coordination by allowing providers to access claims-based 
reports, including patient lists, patient conditions, and histories of 
services provided. 

Although the state had not conducted a formal (external) evaluation, 
state officials internally analyzed claims data for fiscal years 2007 
through 2009 by analyzing changes in per member per month costs since 
the implementation of the initiative, and they estimated savings of 
$217 million. 

Source: GAO analysis of state data. 

[A] In addition to the three payment types, providers receive one-time 
funding from the state for their first year as a participant in the 
initiative. 

[B] Payments for other patients are slightly higher: $3 per adult, and 
$4 per disabled or elderly patient. 

[End of table] 

Table 3: Description of New York's Care Coordination Initiative, 
Patient-Centered Medical Home: 

Initiative overview: 
New York started its initiative in 2009 to provide financial 
incentives for providers to become medical homes for Medicaid 
patients; 
* New York's initiative is available to Medicaid-covered 
children and adults. CHIP-covered children are not covered by the 
initiative; 
* The initiative is available to those that receive care 
in a fee-for-service delivery model as well as those receiving care in 
a managed care delivery model; 
* Only primary care providers 
participate in the program. 

Provider participation requirements: 
Providers are approved to participate in the state's medical home 
initiative once they have been officially recognized by the Patient-
Centered Medical Home program of the National Committee for Quality 
Assurance (NCQA).[A] Providers can be recognized at one of three 
different medical home tiers, depending on the amount and level of 
services the practice offers. Areas in which physician practices are 
evaluated and scored include: 
* using written standards on patient access and communication with 
patients; 
* using electronic health information to track patients' medical 
conditions and important diagnoses; 
* implementing evidence-based guidelines for at least three medical 
conditions; 
* tracking referrals to other physicians; and; 
* conducting performance reports for the practice or by provider. 

Provider payment: 
Providers recognized as a medical home receive two types of enhanced 
payments. The type of payment is based on the delivery model in which 
their Medicaid and CHIP patients are enrolled, and the amount of the 
payment increase is based on the provider's medical home tier; 
* For children served under a managed care model, an additional per 
member per month payment is made, with larger payment increases for 
physicians recognized at higher medical home tiers. Tier 1 providers 
are paid a $2 per member per month, tier 2 providers are paid an 
additional $4 per member per month, and tier 3 providers are paid an 
additional $6 per member per month; 
* For children served under fee-for-service model, payment amounts are 
increased for certain office-based services. The amount of the payment 
increase can range from about $5 to $21, depending on the medical home 
tier of the practice, with the higher tiers receiving larger payment 
increases. 

Monitoring, support, and evaluation: 
New York officials told us in 2010 that because the program was so new 
that they had not yet established a process to monitor or evaluate 
outcomes of the initiative. They added that since the initiative began 
the number of physicians and practices that had been recognized as a 
medical home had dramatically increased.[B]. 

Source: GAO analysis of state data. 

[A] NCQA is a nationally recognized not-for-profit organization that 
develops health care quality and performance standards and accredits 
health plans, physicians, and other health care providers. NCQA 
assesses and scores physician practices using standards that emphasize 
the use of systematic, patient-centered, and coordinated care 
management processes. 

[B] According to a state official, prior to the state's implementation 
of the initiative the number of physicians with NCQA recognition was 
about 300, but has increased three-fold since implementation of the 
state's initiative. 

[End of table] 

Table 4: Description of North Carolina's Care Coordination Initiative, 
Community Care of North Carolina: 

Initiative overview: 
In 1998, North Carolina expanded an existing care coordination 
initiative that focused on certain populations, and introduced 
Community Care of North Carolina, a system of health and community 
networks across the state, to implement care coordination statewide[A]; 
* North Carolina's initiative is available to Medicaid-covered 
children.[B] The initiative is also available to adults with 
Medicaid coverage; 
* Enrollment in the initiative is mandatory for Medicaid-covered 
children ages 1-18; 
* As of March 2010, nearly 800,000 Medicaid-covered children were 
enrolled in Community Care of North Carolina; 
* Care is provided through a fee-for-service delivery model; 
* Most of the providers participating in the initiative are primary 
care providers, because specialists do not typically meet some of the 
requirements for approval. 

Provider participation requirements: 
Providers are approved to participate in the initiative by signing an 
agreement with the state.[C] Services they agree to provide include: 
* being available for medical consultation 24 hours a day, 7 days a 
week; 
* offering preventive services; 
* arranging referrals as needed; 
* providing translation services; 
* referring and coordinating care; 
* implementing quality improvement and disease management initiatives; 
* conducting medical chart audits, and; 
* reducing inappropriate utilization of services. 

Provider payment: 
North Carolina pays providers a per member per month 
payment. This payment is based on the number of aged, blind, or 
disabled beneficiaries for whom a provider serves as a medical home. 
The following rates are paid monthly: 
* $5 for each aged, blind, or disabled patient, and $2.50 for other 
patients. 

Monitoring, support, and evaluation: 
North Carolina monitors several 
health care measures that are collected from claims data and annual 
chart reviews. Measures that are monitored include: 
* preventable hospital readmissions as a percentage of total hospital 
admissions; 
* percentage of providers who use electronic prescribing, and; 
* rates of emergency room visits for asthma patients. 
The state has funded two external evaluations of the Community Care of 
North Carolina: 
* A study by Mercer Consulting Group estimated that for state fiscal 
year 2009 savings from the program were between $187 and $195 million. 
Estimated savings were determined by comparing state costs under 
Community Care of North Carolina to projections of what state costs 
would have been under the previous program using historical data; 
* An earlier study of the program's initial disease management 
initiatives conducted by the University of North Carolina's Cecil G. 
Sheps Center estimated Medicaid savings of $3.3 million for people with 
asthma and $2.1 million for diabetes patients between 2000 and 2002. 
Much of these cost savings came from a reduction in hospital and 
emergency room admissions. Estimated savings were determined by 
comparing the average per member per month costs for these patients 
under the Community Care of North Carolina program with costs prior to 
the implementation of the program.[D]. 

Source: GAO analysis of state data. 

[A] The state's existing care coordination initiative focused on 
patients with diabetes and asthma. 

[B] According to a North Carolina official, in October 2009, North 
Carolina temporarily discontinued care coordination payments for CHIP-
covered children because the state lacked data needed to determine the 
program's effect on CHIP costs. The state plans to resume these 
payments after they have implemented a system to collect the needed 
data. 

[C] By signing the agreement with the state, providers become a member 
in 1 of the 14 geographic networks established across the state. Each 
network has a clinical director who provides leadership and is a leader 
in the local medical community. The providers govern their local 
network and hold regular medical management meetings, where they look 
at data related to their local network and compare their outcomes to 
those of other networks in the state. 

[D] T.C Ricketts, et al., "Evaluation of Community Care of North 
Carolina Asthma and Diabetes Management Initiatives: January 2000-
December 2002," The Cecil G. Sheps Center for Health Services Research, 
Chapel Hill, NC (Apr. 15, 2004), available at [hyperlink, 
http://www.communitycarenc.com/PDFDocs/Sheps%20Eval.pdf]. 

[End of table] 

Table 5: Description of Oklahoma's Care Coordination Initiative, 
SoonerCare Choice: 

Initiative overview: 
In 2009, Oklahoma transitioned its Medicaid program from a managed 
care delivery model to a fee-for-service model called SoonerCare 
Choice that utilizes a primary care case management system to provide 
a medical home[A]; 
* Oklahoma's initiative is available to Medicaid-and CHIP-covered 
children. The initiative is also available to adults with Medicaid 
coverage; 
* In state fiscal year 2009, approximately 438,000 children 
participated in the initiative; 
* Specialists cannot serve as a medical home. 

Provider participation requirements: 
Providers are approved to participate in the initiative by signing an 
agreement with the state. The state requirements include a minimum and 
maximum number of patients per provider. At a minimum, all 
participating providers must serve at least 50 Medicaid-and CHIP-
covered patients. The maximum number of patients is 2,500 for 
physicians and 1,250 for mid-level providers, such as nurse 
practitioners. Practices can be approved at one of three tiers based 
on their ability to meet the different requirements at each tier. 

Tier 1: Entry-level medical home: 
Providers must: 
* provide or coordinate all medically necessary primary and preventive 
services; 
* organize clinical data in paper or electronic format; 
* review all medications a patient is taking and maintain a medication 
list; maintain a system to track, test, and follow-up on results; 
* maintain a system to track referrals including self-reported 
referrals; 
* provide care coordination including family participation; and; 
* provide patient education and support. 

Tier 2: Advanced-level medical home: 
In addition to Tier 1 requirements, providers must accept electronic 
communications from the state's Medicaid office; 
* provide 24 hours a day, 7 days a week availability; 
* make after-hours care available to patients (provider must be 
available at least 30 hours per week and have open scheduling and walk-
ins to provide continuity of care); 
* use mental health and substance abuse screening and referral; 
* use data from state Medicaid office to identify and track patients 
inside and outside of their practice; 
* coordinate care for patients who receive care outside the primary 
care provider location; and; 
* promote access and communication with patients. 

Tier 3: Optimal-level medical home: 
In addition to Tier 1 and 2 requirements, providers must: 
* organize and train staff in roles for care management, and create 
and maintain a prepared and proactive care team; 
* provide timely call-back to patients; 
* use health assessments to characterize patient needs and risks; 
* document patient self-management plan for those with chronic disease; 
* develop a primary care provider-led health care team; 
* provide after-visit follow-up for patients; 
* adopt specific evidence-based clinical practice guidelines on 
preventive and chronic care; and; 
* use medication reconciliation to avoid adverse interactions. 

Provider payment: 
Oklahoma pays providers participating in the initiative in two ways: 
per member per month coordination payment and performance-based 
payments; 
* Per member per month care coordination payments differ by patient 
type and; provider tier: 

Type of practice: Children only; 
Tier 1: $3.58; 
Tier 2: $4.65; 
Tier 3: $6.12. 

Type of practice: Children and adults; 
Tier 1: $4.33; 
Tier 2: $5.64; 
Tier 3: $7.50. 

Type of practice: Adults only; 
Tier 1: $5.02; 
Tier 2: $6.53; 
Tier 3: $8.69. 

* Performance payments are paid quarterly to providers that achieve 
different quality goals, related to providing well-child health 
examinations and reduction of emergency room visits. 

Monitoring, support, and evaluation: 
The state monitors and supports providers in numerous ways. For 
example, the state: 
* maintains a database to monitor participating providers and 
practices, and uses the database to help medical homes identify 
specialists for patient referrals, and monitor the number of patients 
served by providers; 
* has developed a medical home review tool and is conducting 
educational reviews of providers and practices participating in the 
state initiative to identify the extent to which providers are 
providing the medical home services required for their respective 
tier; and; 
* maintains a log of calls, which are categorized and tracked from year 
to year, that the state agency has received on access-related issues. 
The state has not conducted a formal (external) evaluation of this care 
coordination program. 

Source: GAO analysis of state data. 

[A] The state also has two smaller care coordination initiatives for 
high-risk patients. 

[End of table] 

[End of Enclosure III] 

Enclosure IV: Comments from the Department of Health and Human 
Services: 

Department Of Health & Human Services:	
Office Of The Secretary: 
Assistant Secretary for Legislation: 
Washington, DC 20201: 

March 18, 2011: 

Katherine Iritani:	
Acting Director, Health Care: 
U.S. Government Accountability Office: 
441 G Street N.W. 
Washington, DC 20548: 

Dear Ms. Iritani: 

Attached are comments on the U.S. Government Accountability Office's 
(GAO) correspondence entitled: "Medicaid and CHIP: Reports for 
Monitoring Children's Health Care Services Need Improvement" (GAO-11-
293R). 

The Department appreciates the opportunity to review this 
correspondence before its publication. 

Sincerely, 

Signed by: 

Jim R. Esquea: 
Assistant Secretary for Legislation: 

Attachment: 

[End of letter] 

General Comments Of The Department Of Health And Human Services (HHS) 
On The Government Accountability Office's (GAO) Draft Correspondence 
Entitled, "Medicaid And Chip: Reports For Monitoring Children's Health 
Care Services Need Improvement" (GAO-11-293R): 

Thank you for the opportunity to review and comment on this draft 
report. 

GAO issued two recommendations to the Department. We concur with both 
recommendations and offer comments below, particularly regarding the 
second recommendation as written. 

GAO Recommendation: 

The Administrator of CMS should establish a plan, with goals and time 
frames, to review the accuracy and completeness of information 
reported on the CMS-416 and CHIP Annual Reports and ensure identified 
problems are corrected. 

Centers for Medicare & Medicaid Services (CMS) Response: 

We agree with this recommendation and are already engaged in efforts 
with States to improve the accuracy and completeness of information 
collected by the CMS-416 and CHIP Annual Reports.	As stated, these 
efforts could benefit from establishing precise goals and concrete
timeframes. 

The CMS is currently undertaking the following steps to address this 
concern: 

1) Over the past 18 months, the Center for Medicaid, CHIP and Survey & 
Certification (CMCS) within CMS has been working closely with States 
to improve their understanding of EPSDT and the data reporting 
requirements. CMS held two "EPSDT Listening Sessions" in late 2009 to 
obtain input from State Medicaid Programs and national organizations 
on recommendations for improving service delivery, and monitoring and 
assessment of health outcomes related to EPSDT. In addition, CMS has 
held three EPSDT training sessions for CMS staff in both the Central 
Office and Regional Offices. One of these training sessions, held in 
October 2010, focused solely on the new data collection requirements 
for the CMS-416. CMS issued a revised form CMS-416 and instructions in 
late December 2010 that included changes as required by CHIPRA as well 
as requested by the Oral Health Technical Advisory Group (an advisory 
group made up of state Medicaid dental directors). The changes will 
provide CMS and States with a more complete profile of dental services 
provided to children. CMCS also currently serves on the National 
Academy for State Health Policy EPSDT Advisory Committee, a group that 
includes State EPSDT staff and provides guidance to State Medicaid 
staff administering the EPSDT benefit. 

2) Additionally, in December 2010, CMS established a National EPSDT 
Improvement Workgroup which includes several sub-workgroups including 
a Data Improvement SubWorkgroup. The workgroup members represent a 
wide range of perspectives, experience with and knowledge of EPSDT. 
The members also have experience with the challenges States have faced 
in collecting and reporting useful Medicaid and CHIP performance data. 
The members of the Data Improvement Sub-Workgroup will lend their 
expertise to inform CMS' development of a plan for improving the 
quality and usefulness of the data reported on the CMS-416. 

3) In an effort to reduce variation in the accuracy and completeness 
of data submitted to CMS via the CMS-416, an internal EPSDT workgroup 
at CMS has begun developing a set of data validation methods, 
including instituting a number of data integrity checks and procedures 
for monitoring and flagging questionable data or substantial year-to-
year variation. Until more automated processes are in place, the 
workgroup is discussing how to implement a process for conducting 
regular internal audits of all changes made to EPSDT databases to 
reduce and prevent the possibility of data reporting errors by CMS. 
CMS also recently developed a crosswalk and additional guidance to 
assist States in collecting and reporting CMS-416 data that is more 
complete, accurate, and user-friendly. The crosswalk is a two-page 
instructional resource that defines each line of the CMS-416 using 
more simplified and straightforward terms, provides examples of 
potential responses, and provides edit checks in a notes column. The 
document will be issued to States in the coming months. 

4) Major efforts are also underway to improve information on access 
and quality of care provided through the CHIP annual reports. CHIPRA 
gives CMS new authority and resources to monitor the services provided 
to children enrolled in Medicaid and CHIP. These provisions are 
helping CMS build an infrastructure for Medicaid/CHIP to measure and 
report on health care access and quality for children using a uniform 
set of tools across the States. This infrastructure has included 
indentifying an initial core set of child health quality measures for 
voluntary use by States, $100 million in grant funding to States to 
develop quality and performance measurement tools and strategies, and 
developing a Pediatric Quality Measures Program to refine the core 
quality measures and assist States in analyzing the data yielded from 
these efforts for use in quality improvement efforts. In February 
2011, CMS issued technical specifications for the standardized 
reporting of the CHIPRA core set of measures and CMS is now developing 
plans for providing States with technical assistance on collecting the 
data and using the information for quality improvement purposes. (See: 
[hyperlink, 
http://www.cms.gov/MedicaidCHIPQualPrac/Downloads/CHIPRACoreSetTechManua
l.pdf]) 

GAO Recommendation: 

The Administrator of CMS should work with States to identify 
additional improvements that could be made to the CMS-416 and CHIP 
Annual Reports, including options for reporting on the receipt of 
services separately for children in managed care and fee-for-service 
delivery models, while minimizing reporting burden, and for capturing 
information on the CMS-416 relating to children's receipt of treatment 
services for which they are referred. 

CMS Response: 

We agree with this recommendation. Over the past year CMS has been 
working to identify options for improving the value of the CMS-416 as 
well as the CHIP Annual Reports. CMS is striving to strike a balance 
between targeting resources to upgrade existing data collection tools 
and investing in new tools that can ultimately reduce the duplication 
of efforts. CMS is also striving to enhance CMS and the States' 
collective capacity to address the complex challenge of ensuring 
access to care for the diverse population groups that Medicaid and 
CHIP serve. CMS' goal is to work together with States to determine the 
data reporting elements that will be most effective in measuring 
quality and performance of these programs. In general, CMS is 
interested in working with States and stakeholders to develop data and 
a set of measures that will achieve consistency across States and 
ensure a higher quality of valued information. 

CMCS Data Strategy: 

The CMS is currently working with States through its CHIPRA quality 
demonstration grantees and its Technical Advisory Groups, (which are 
state workgroups that focus on policy areas such as quality, oral 
health, mental health, managed care, and coverage) to strengthen 
systems for measuring and collecting data on access and quality. In 
addition, efforts are now underway under the leadership of our Data 
and Systems Group to develop a larger strategy to meet the data and 
information exchange needs of CMS and the States. Two such efforts to 
improve the timeliness and accuracy of data reported deserve note. CMS 
is investing considerable resources in improving the Medicaid 
Statistical Information System and expanding the use of electronic 
health records (EHRs). Both of these information sources have 
efficiencies and capacities to collect more detailed information than 
either the CMS-416 or CHIP Annual Reports. Though widespread adoption 
of EHRs is not expected until 2014, leveraging EHRs where possible 
today, and working toward a future in which data are electronically 
collected and shared, is an investment that CMS expects will have a 
great value over time in not only improving the quality of care, but 
also in improving CMS's capacity to monitor services provided to 
beneficiaries. 

It is our aim that with the help of the National EPSDT Workgroup, 
which will be discussing, among other things, the use of EHRs to 
collect information on children's use of services as required by 
EPSDT, there may be additional enhancements to the CMS-416 that 
enlighten the way we collect data now and in the future, and help 
improve upon the quality of information available to States and CMS.
Information Sources for Monitoring Access and Quality
Starting in 2013, CHIPRA requires CHIP programs and CHIP Medicaid 
Expansion programs to include in their CHIP Annual Report data from a 
monitoring tool, the Consumer Assessment of Healthcare Providers and 
Systems (CARPS).[Footnote 1] The CAHPS survey tool is also a component 
of the CHIPRA initial core set of quality measures for voluntary use 
by State Medicaid/CHIP programs. It includes a number of questions 
about beneficiaries' satisfaction in accessing primary and specialty 
care, including questions about the ease of receiving needed care. 
While the CMS-416 could be expanded to collect more detailed 
information on children's receipt of needed services, it would 
duplicate information now being requested of States through CAHPS. As 
we work to make modifications to the CMS-416 to improve the accuracy 
of the information it captures, we believe the use of CARPS in the 
future will prove to capture beneficiaries' experiences in accessing 
EPSDT benefits in an even more useful manner. 

Several surveys conducted by the Department of Health and Human 
Services analyzed for this GAO report (the National Survey of 
Children's Health and the Medical Expenditure Panel Survey) are also 
excellent tools to answer questions about the extent to which children 
in Medicaid and CHIP nationwide have access to networks of care and 
coordinated care.
Although the surveys are not State-specific, they offer insights into 
services provided to children enrolled in Medicaid/CHIP and collect 
individual data that can be stratified by demographic and health 
characteristics that are useful for monitoring access to quality care. 

Managed Care Improvement Initiative: 

The CMS also has a number of tools and a new initiative underway for 
monitoring access and quality of care in managed care arrangements. 
With respect to the CMS-416, current instructions specify that data 
reported on the form must include services delivered to individuals in 
both fee-for-service or managed care arrangements. While CMS 
recognizes the challenges States face in collecting service use data 
from plans that use a capitated payment system, we are committed to 
working with States to identify the most critical data elements that 
will enable both the Federal government and the States to more 
effectively monitor and oversee access to care provided through 
managed care delivery systems. In particular, we are working to 
improve collection and reporting of encounter data. CMS is in the 
process of drafting regulatory guidance on reporting of encounter data 
to CMS in a consistent format across programs. Ultimately, programs 
will be required to report data more frequently to ensure an ongoing 
flow of accurate and timely information, thus improving CMS' oversight 
capabilities. 

In addition, Medicaid and now CHIP programs that contract with prepaid 
managed care organizations are required to conduct annual external 
quality reviews (EQR). The EQRs are required by Congress, and CHIPRA 
requires that CMS report on an annual basis the lessons learned from 
the EQRs. CMS is now in the process of updating its protocols for EQRs 
and will issue new guidance to States to strengthen the collection and 
validation of encounter data on services provided by managed care 
organizations. 

Improving the quality of information available on children's access to 
care in Medicaid and CHIP is one of CMS's key priorities, and the onus 
of improving the data collected rests both on the States and CMS. It 
is our view that the collection of data reported on the CMS-416 and 
CHIP Annual Reports will benefit from these targeted efforts, as well 
as CMS-wide efforts underway to improve the collection and reporting 
of data on quality of care measures more broadly. We appreciate the 
efforts that went into this report and look forward to working with 
the GAO on this and other issues. 

Enclosure IV Footnote: 

[1] Currently, 33 States are either CHIP combination or Medicaid 
Expansion programs. 

[End of Enclosure IV] 

Enclosure V: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Katherine Iritani, Acting Director, (202) 512-7114 or iritanik@gao.gov: 

Staff Acknowledgments: 

In addition to the contact named above, Catina Bradley, Assistant 
Director; Tim Bushfield; Sean DeBlieck; Alison Goestch; Laura Henry; 
Shirin Hormozi; Hannah Locke; Roseanne Price; and Hemi Tewarson made 
key contributions to this report. Martha Kelly and Suzanne Worth, 
Assistant Directors, provided technical assistance. 

[End of Enclosure V] 

Related GAO Products: 

Oral Health: Efforts Under Way to Improve Children's Access to Dental 
Services, but Sustained Attention Needed to Address Ongoing Concerns. 
[hyperlink, http://www.gao.gov/products/GAO-11-96]. Washington, D.C.: 
November 30, 2010. 

Health Care Delivery: Features of Integrated Systems Support Patient 
Care Strategies and Access to Care, but Systems Face Challenges. 
[hyperlink, http://www.gao.gov/products/GAO-11-49]. Washington, D.C.: 
November 16, 2010. 

Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs 
Improvement. [hyperlink, http://www.gao.gov/products/GAO-10-810]. 
Washington, D.C.: August 4, 2010. 

Medicaid Preventive Services: Concerted Efforts Needed to Ensure 
Beneficiaries Receive Services. [hyperlink, 
http://www.gao.gov/products/GAO-09-578]. Washington, D.C.: August 
14, 2009. 

Medicaid: Concerns Remain about Sufficiency of Data for Oversight of 
Children's Dental Services. [hyperlink, 
http://www.gao.gov/products/GAO-07-826T]. Washington, D.C.: May 2, 
2007. 

Medicaid Managed Care: Access and Quality Requirements Specific to Low-
Income and Other Special Needs Enrollees. [hyperlink, 
http://www.gao.gov/products/GAO-05-44R]. Washington, D.C.: 
December 8, 2004. 

Medicaid and SCHIP: States Use Varying Approaches to Monitor Children's 
Access to Care. [hyperlink, http://www.gao.gov/products/GAO-03-222]. 
Washington, D.C.: January 14, 2003. 

Medicaid: Stronger Efforts Needed to Ensure Children's Access to Health 
Screening Services. [hyperlink, 
http://www.gao.gov/products/GAO-01-749]. Washington, D.C.: July 13, 
2001. 

[End of section] 

Footnotes: 

[1] State Medicaid programs generally cover children under 21 years of 
age; however, state CHIP programs generally cover children 18 years of 
age and younger. 

[2] For the 2009 report, we examined national surveys conducted by the 
Department of Health and Human Services from 2003 through 2006. The 
surveys included information from parents, or other adults in the 
household, of children in Medicaid and CHIP about the receipt of well-
child checkups. See GAO, Medicaid Preventive Services: Concerted 
Efforts Needed to Ensure Beneficiaries Receive Services, [hyperlink, 
http://www.gao.gov/products/GAO-09-578] (Washington, D.C.: Aug. 14, 
2009). See the list of related GAO products at the end of this report. 

[3] There are also other definitions of care coordination. See GAO, 
Health Care Delivery: Features of Integrated Systems Support Patient 
Care Strategies and Access to Care, but Systems Face Challenges, 
[hyperlink, http://www.gao.gov/products/GAO-11-49] (Washington, D.C.: 
Nov. 16, 2010). 

[4] See 42 U.S.C. § 1396a(a)(43). 

[5] For this report, we refer to the EPSDT periodic screening services 
as well-child checkups. Under the EPSDT benefit, children also must 
receive coverage of treatment and other services necessary to correct 
or ameliorate health conditions discovered through well-child 
checkups. 42 U.S.C. §§ 1396a(a)(10), 1396d(4)(A). 

[6] See 42 U.S.C. § 1397hh(a). 

[7] We have long recommended that agencies collect information for 
overseeing the programs they administer. Internal control standards 
specify that agencies should collect information to monitor program 
objectives in order to determine whether the agencies are meeting 
their strategic goals. See GAO, Standards for Internal Control in the 
Federal Government, [hyperlink, 
http://www.gao.gov/products/GAO/AIMD-00-21.3.1] (Washington, D.C.: 
November 1999). 

[8] Under federal law, CMS must develop and set annual goals for each 
state for the participation of eligible children in EPSDT services. 42 
U.S.C. § 1396d(r)(5). 

[9] In some cases, children may receive care through a Primary Care 
Case Management (PCCM) model. Under a PCCM model, primary care 
providers are prepaid a small amount for each enrollee to manage and 
coordinate the enrollee’s health care. Providers are paid on a fee-for-
service basis for care that they provide. 

[10] Pub. L. No. 111-3, § 402(d), 123 Stat. 84. In conjunction with 
this study, we are also separately examining primary care and 
specialty care physicians’ willingness to serve children in Medicaid 
and CHIP, which was also required under CHIPRA. As we agreed with your 
staff, we plan to issue a separate report in 2011. 

[11] The NSCH is administered by HHS’s National Center for Health 
Statistics, which collects data from parents and guardians on their 
children’s health and use of medical services. The NSCH collects 
information about children 17 years of age and younger. We analyzed 
the NSCH’s measure of effective care coordination from 2007 (the most 
recent data available) for children 17 years of age and younger. 

[12] The NSCH identifies children needing care coordination and 
assesses whether or not these children received effective care 
coordination. The NSCH classifies children as needing care 
coordination if the child received services from two or more different 
categories of care (preventive medical, preventive dental, mental 
health care, or specialist services), and the family received any help 
or needed extra help coordinating the child’s care. The NSCH 
classifies these children as receiving effective care coordination if 
they usually received extra help coordinating care when it was needed, 
and were very satisfied with communication between doctors, and 
communication between doctors and other entities when such 
communication was needed. For the purposes of our report, we 
classified children as not receiving care coordination if the NSCH 
indicated that they did not receive effective care coordination when 
needed. 

[13] The MEPS is administered by HHS’s Agency for Health Care Research 
and Quality, which collects data from individuals and their medical 
providers on, among other things, health status, use of medical care 
services, and access to care. For consistency with NSCH, we analyzed 
MEPS survey results for children 17 years of age and younger. We 
analyzed data related to access to networks of care for children 17 
years of age and younger from the 2005, 2006, and 2007 surveys: (a) 
the proportion of children who had problems receiving needed care, 
tests, or treatments, and (b) the proportion who experienced problems 
accessing needed specialists. Although 2008 MEPS survey data were 
available, the questions we examined related to access to networks of 
care were no longer included. As a result, we were unable to compare 
the 2008 data to the data for 2005, 2006, and 2007. 

[14] The Patient Protection and Affordable Care Act, enacted on March 
23, 2010, provides states with a new option for offering health homes 
(i.e., a designated provider, a team of health care professionals 
operating with such a provider, or a health team) for Medicaid 
beneficiaries with chronic conditions beginning in January 2011. 
Subject to CMS approval, states may make Medicaid payments for health 
home services, including comprehensive care management, care 
coordination, and comprehensive transitional care, provided by a team 
of health care professionals. Pub. L. No. 111-148, § 2703, 124 Stat. 
119, 319 (Mar. 23, 2010). CMS provided state Medicaid and health 
officials with preliminary guidance on the implementation of health 
homes in November 2010. We did not assess the implementation of this 
option by states in this review. 

[15] We did not identify a commonly accepted definition of a medical 
home. For purposes of this report, a medical home is generally a 
provider who is able to both provide and coordinate comprehensive 
health care services for patients. 

[16] Under CHIPRA, HHS must publish a set of core measures for 
evaluating the quality of care provided to children in Medicaid and 
CHIP, which states may choose to use for reporting to HHS. Pub. L. No. 
111-3, § 401(a), 123 Stat. 72. HHS published a set of 24 measures on 
December 29, 2010, which include three performance measures from the 
CHIP annual report. 

[17] CHIPRA requires states to expand the information included in CHIP 
annual reports. Pub. L. No. 111-3, § 402(a), 123 Stat. 82. In 
accordance with this mandate, beginning in 2013, CMS will require 
states to report additional information for their CHIP beneficiaries 
through satisfaction surveys, including information on access to 
primary and specialty services, access to networks of care, and care 
coordination for beneficiaries. 

[18] State Medicaid programs generally cover children under 21 years 
of age; however, state CHIP programs generally cover children 18 years 
of age and younger. 

[19] GAO, Medicaid Preventive Services: Concerted Efforts Needed to 
Ensure Beneficiaries Receive Services, [hyperlink, 
http://www.gao.gov/products/GAO-09-578] (Washington, D.C.: Aug. 14, 
2009). 

[20] For purposes of this briefing, care coordination is broadly 
defined as a process in which an individual or group helps arrange 
primary and specialty health care services. Care coordination can be 
provided by primary care providers or through other individuals, such 
as social workers or case managers. 

[21] The EPSDT benefit generally entitles eligible children to receive 
coverage of periodic screening services that include a comprehensive 
health and developmental history, a comprehensive physical 
examination, appropriate immunizations, laboratory tests, and health 
education. For the purposes of this briefing, we also refer to EPSDT 
screening services as well-child checkups. States are also required to 
cover other EPSDT services, such as vision, dental, and hearing 
services, and further diagnostic or treatment services necessary to
correct or ameliorate health conditions discovered through well-child 
checkups. 

[22] Pub. L No. 111-3, § 402(d), 123 Stat. 8, 84 (2009). 

[23] Although 2008 MEPS data were available, the questions we examined 
related to access to networks of care were no longer included.
As a result, we were unable to compare the 2008 data to the data for 
2005, 2006, and 2007. 

[24] Under managed care, states provide a set payment amount in 
advance to managed care organizations to provide services to 
beneficiaries. 

[25] Fiscal year 2008 is the most recent year for which there was 
reporting from all states. 

[26] This includes the District of Columbia. 

[27] See GAO, Medicaid: Concerns Remain about Sufficiency of Data for 
Oversight of Children's Dental Services, [hyperlink, 
http://www.gao.gov/products/GAO-07-826T] (Washington, D.C.: May 2, 
2007). 

[28] Since 1990, CMS has been required under federal law to develop 
and set annual participation goals for each state for participation of 
eligible children in EPSDT services. 

[29] See [hyperlink, http://www.gao.gov/products/GAO-09-578]. 

[30] All percentage estimates from MEPS and NSCH data have a margin of 
error of plus or minus 5 percent or less at the 95 percent confidence 
level, unless otherwise noted. 

[31] The confidence interval for this estimate is plus or minus 6 
percent at the 95 percent confidence level. 

[32] The NSCH measures whether children needing care coordination 
received effective care coordination. The NSCH classifies children as 
needing care coordination if the child received services from two or 
more different categories of care (preventive medical, preventive 
dental, mental health care, or specialist services), and the family 
received any help or needed extra help coordinating the child's care. 
The NSCH classifies these children as receiving effective care 
coordination if they usually received extra help coordinating care 
when it was needed, and were very satisfied with communication between 
doctors, and communication between doctors and other entities when 
such communication was needed. For the purposes of this briefing, we 
classified children as not receiving care coordination if the NSCH 
indicated that they did not receive effective care coordination when 
needed. 

[33] For privately insured children, the 2007 NSCH survey suggests 
that 41 percent of children 17 years of age and younger, or an 
estimated 18 million, needed care coordination services. 

[34] For privately insured children 17 years of age and younger whose 
families reported needing care coordination services, the 2007 NSCH 
survey suggests that 26 percent, or an estimated 5 million, did not 
receive the needed services. 

[35] The confidence interval for this estimate is plus or minus 6 
percent at the 95 percent confidence level. 

[36] For purposes of this briefing, a medical home is generally 
defined as a provider who is able to both provide and coordinate 
comprehensive health care services for patients. 

[37] See GAO, Standards for Internal Control in the Federal 
Government, [hyperlink, 
http://www.gao.gov/products/GAO/AIMD-00-21.3.1] (Washington, D.C.: 
November 1999). 

[38] Although the CMS 416 collects the number of children enrolled in 
managed care, it does not collect separate information on receipt of 
services for these children. As with the CMS 416, performance measures 
are not reported separately by delivery model on the CHIP annual 
report. States are allowed to only report performance measures for the 
delivery model with the largest number of enrollees. 

[39] See GAO, Oral Health: Efforts Under Way to Improve Children's 
Access to Dental Services, but Sustained Attention Needed to Address 
Ongoing Concerns, [hyperlink, http://www.gao.gov/products/GAO-11-96] 
(Washington, D.C.: Nov. 30, 2010). 

[40] Under CHIPRA, HHS is required to collect information on the 
quality of care provided to Medicaid- and CHIP-enrolled children from 
states and analyze and report these data beginning in September 2010 
and annually thereafter. 

[41] MSIS is a CMS system that collects eligibility and claims data 
from states. CMS uses this system to produce eligibility and program 
characteristics. 

[42] Under CHIPRA, HHS must publish a core set of measures for 
evaluating the quality of care provided to Medicaid- and CHIP-covered 
children, which states may choose to use for reporting to HHS. HHS 
published a set of 24 measures on December 29, 2010, which include 
three performance measures from the CHIP annual report: receipt of 
well-child visits during the first 15 months of life; receipt of well-
child visits in the third, fourth, fifth, and sixth years of life; and 
children's access to primary care providers. 

[43] The expert panel includes representatives from other federal 
agencies, state Title V leaders, family organizations, and child 
health researchers. 

[44] The NSCH only includes information for children 17 years of age 
or younger. 

[45] For purposes of our report, we classified children as not 
receiving care coordination if the NSCH indicated that they did not 
receive effective care coordination when needed. 

[46] Although 2008 MEPS survey data were available, the questions we 
examined related to access to networks of care were no longer 
included. As result, we were unable to compare the 2008 data to the 
data for 2005, 2006, and 2007. 

[47] For the purposes of this report, a formal evaluation is a study or 
assessment of the care coordination initiative that is conducted by an 
external research entity. Some states completed internal reviews and 
studies as part of the process of overseeing their initiatives. While 
we provide information on the findings of internal state studies, we do 
not report them as formal evaluations. 

[End of section] 

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