Child Health Check-Up (formerly EPSDT) - Herman & Associates ...

Child Health Check-Up Coverage and Limitations HandbookService Requirements, continuedRequiredComponentsTo be reimbursed by Medicaid, the provider must assess and document in thechild’s medical record all the required components of a Child Health Check-Up.The required components are as follows:• Comprehensive Health and Developmental History including assessment ofpast medical history, developmental history and behavioral health status;• Nutritional assessment;• Developmental assessment;• Comprehensive unclothed physical examination;• Dental screening including dental referral, when required;• Vision screening including objective testing, when required;• Hearing screening including objective testing, when required;• Laboratory tests including blood lead testing, when required;• Appropriate immunizations;• Health education, anticipatory guidance;• Diagnosis and treatment; and• Referral and follow-up, as appropriate.Note: See the specific component topics in this chapter for detailed informationon the components.Note: See Appendix G for the Child Health Check-Up Audit Tool. The ChildHealth Check-Up Audit Tool is to be used for all Provider Types by Medicaidreviewers and auditors in assessing policy compliance.PreviouslyProvidedComponentIf a component was performed within approximately 90 days before the ChildHealth Check-Up and the results were documented, the provider does not needto repeat the component. An exception should be made if the child’senvironment or medical condition indicates that the component should berepeated.Or if, based on medical discretion, a component has not been performed withinapproximately 90 days, but within a reasonable time based on the child’s ageand with documentation of medically appropriate rationale, i.e., 2 year oldparticipates in the Early Intervention program, the provider does not need torepeat the component.2-2 October 2003