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

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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
Child Health Check-Up Coverage and Limitations HandbookService Requirements, continuedChild HealthCheck-Up FormsProviders may use the Child Health Check-Up Tracking Forms to address anddocument the required components. The forms were developed by a workgroupcomposed of members of the Florida Pediatric Society, the Florida Chapter ofthe American Academy of Pediatrics; the Florida Academy of FamilyPhysicians; the Florida Medical Association; and the Florida OsteopathicMedical Association. These forms were designed to capture all requiredcomponents of the Child Health Check-Up.Medicaid’s Child Health Check-Up Program also has an optional InitialComprehensive Health and Developmental History Form that may be used.Use of these forms is optional; however, if a provider does not use the forms, heor she must still assess and document all the required components.Note: See Appendix B for a copy of the optional Child Health Check-UpTracking Forms and Appendix C for a copy of the optional Child Health Check-Up Initial Comprehensive Health and Developmental History Form. The providermay make photocopies of the form(s) to use for Child Health Check-Ups.If the Child is SickA Child Health Check-Up should not be performed on an obviously sick childwhere findings may be distorted. Provider discretion in evaluating the degree ofillness should determine if a Child Health Check-Up should be performed.Providers may only bill for one visit, a sick visit or a Child Health Check-Up. Ifthe child is sick, the provider should treat or refer the child for the illness andreschedule the Child Health Check-Up.Diagnosis,Treatment, Referraland Follow-UpUnder federal law, Florida provides medically necessary treatment for all medicalconditions that are diagnosed from a Child Health Check-Up.Once the child has had a Child Health Check-Up, any further diagnoses andtreatments, referrals and follow-up are provided through the applicable Medicaidprogram, such as physician services.October 2003 2-3
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Jeb BushGovernorRhonda M. Medows, M
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