Medicaid Managed Care - U.S. Senate Special Committee on Aging

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To what extent does the definition capture the population of children with
special health care needs? Does it include children with or at risk of physical,
behavioral, emotional, and developmental conditions that result in elevated
service needs?
2. Reliability
3. Cost
To what extent is the definition subject to measurement error? For example, a
functional assessment of a chronic condition is subject to the biases of the
person conducting the assessment. Even though children with special health
care needs are acknowledged to share a range of issues across a broad spectrum
of conditions, does the definition contain significant 'gray areas in its
application, such as identifying children at risk of special needs? Would the
definition be consistent across different health plans?
What investment would be required to implement the definition? Do the
benefits of identifying these children outweigh the primary data collection and
administration costs associated with implementation?
4. Acceptability
Is the definition and the steps required to implement it acceptable to payers,
providers, and consumers? If not, is there a way to identify problem areas and
to address them?
5. Availability
To what extent is the definition operational or ready to be implemented for
purposes of identifying children in managed care settings? Is additional
developmental work needed? Has there been adequate testing of the definition
to determine its validity and reliability?
6. Fleribility
Is the definition consistent with the benefit package provided under <strong>Medicaid</strong> or
commercial insurance plans? Are services available once a child with special
health needs is identified? Evaluative criteria must be flexible to address new
advances in condition. recognition and intervention.
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