general src #22, attachment 1: child health check up ... 09/magellan... · importance of child...

General SRC #22, Attachment 1: Child Health Check Up Program

(CHCUP)

Child Health Check-Up Program (CHCUP)

Magellan Complete Care of Florida

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General SRC #22, Attachment 1: Child Health Check Up Program (CHCUP)

Objectives

Upon completion of this training, participants will have an improved understanding of the Child Health Check-Up Program provided by Magellan Complete Care of Florida, including:

•How eligible enrollees are identified•Member education resources•PCP coordination of care•Health Services team member responsibilities•Member outreach and follow-up requirements•Documentation standards

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Child Health Check-Up Program Description

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Child Health Check Up

“Child Health Check-Up” is Florida’s name for the

federal program known as the Early and Periodic

Screening,Diagnosis and Treatment

(EPSDT) program

The purpose of the Child Health Check-Up Program is to provide the following services to children from birth through age 20:· Comprehensive, preventive, well child care on a regularly scheduled basis;· Identification and correction of medical conditions before the conditions become serious and disabling; and· An entry into the health care system and access to a medical home.

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What is the CHCUP?

A set of comprehensive and preventive health examinations provided on a periodic basis to identify and

correct medical conditions in children/adolescents.

Available services for children and adolescents (under age 21) include:•Regular physical exams•Growth measurements•Immunizations•Vision and hearing screenings•Dental screenings•Other important tests and services•Referral for diagnosis and treatment, if necessary

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CHCUP Periodicity Schedule

• Applies to ages: Birth through 20 years old• Comprehensive, preventive health screening service that meets

best practice standards for healthcare• Performed according to a periodicity or whenever medically

necessary or requested by the child or the child’s parent or caregiver.

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Florida Periodicity TableServices Health Check-Up

•Comprehensive Health & Developmental History including 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.

•birth; •2-4 days for newborns discharged in less than 48 hours after delivery;•by 1 month; •2 months; •4 months; •6 months; •9 months; •12 months; •15 months; •18 months; •24 months; •30 months;•once every year for ages 3-20.

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Recommended Immunization Schedule 0-18

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http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

Recommended Adult Immunization Schedule

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http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf

http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf

AHCA/CHCUP Performance Requirements

Provide health screening evaluations according to a standardized periodicity

schedule in compliance with the Medicaid CHCUP Coverage and

Limitations Handbook

Inform enrollees of all testing/screenings due in accordance with the periodicity schedule in the Medicaid CHCUP Services Coverage

and Limitations Handbook and ensure the provider network practices in

accordance with the schedule.

Authorize enrollee referrals to appropriate providers within 4 weeks

for treatment of conditions found during examination. The referral

appointment must occur within six months of the initial examination.

Offer transportation to enrollees in order to assist them to keep, and travel

to, medical appointments

Maintenance of a coordinated system to follow the enrollee the range of

screening and treatment

Achieve a CHCUP screening rate of at least 80% for enrollees continuously

enrolled for at least 8 months

Adopt annual participation goals to achieve at least 80% CHCUP

participation rate

Achieve a preventive dental services rate of at least 39% for enrollees who

are continuously eligible for 90 continuous days.

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MCCFLs Responsibilities for CHCUP

Ask every member, every time!!• Screen child members (birth through 20 years old) to ensure

timely well child visits, immunizations and dental visit according to the periodicty and immunization tables.

• If member is not up-to-date, assist parent or guardian with scheduling appointment and transportation if needed and track to ensure they keep the appointment.

• Document CHCUP visit in TruCare according to the desk top procedure.

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Eligible Enrollees

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Other Sources of information

about enrolled children

Assessment(Health & Wellness

Questionnaire & New Enrollee

Questionnaire)

Claims data Data from Impact Pro

TruCare reports including Key

Metric Reporting

Eligible Enrollees

Eligible enrollees are identified through state enrollment files

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Educational Resources

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Educating the Member

Health Services works with the enrollee/enrollee’s authorized representative and providers to educate them on Child Health Check-up Screenings and to provide approved health education materials from Healthwise.

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Member Educational Resources

•CHCUP screenings are based on national periodicity guidelines according to the American Academy of Pediatrics, Recommendations for Preventive Pediatric Health Care and Florida Medicaid’s recommendation.

Refer to the AHCA Child Health Check-Up Coverage and Limitations Handbook.

AHCA: Medicaid Child Health Services: Child Health Check-Up

Help members understand the importance of Child Health

Check-Up screenings

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http://www.ahca.myflorida.com/medicaid/childhealthservices/chc-up/index.shtml

http://www.ahca.myflorida.com/medicaid/childhealthservices/chc-up/index.shtml


•Determination of whether an inter-periodic Child Health Check-Up is medically necessary may be made by the provider or a health, developmental or educational professional that has contact with the child•Screenings may be requested by the member or the child’s parent or caregiver•No prior authorization is required •The Health Services team offers scheduling assistance and transportation coordination in order to assist enrollees to keep, and travel to medical appointments

Did you know?

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•The Health Services team will be available for office staff and the transportation company to avoid any delays in the services during business hours. •Electronic and written educational materials that are available through Healthwise in English and Spanish suitable for readers with lower reading levels.

Members can access Magellan Complete Care for resources.

Healthwise Knowledgebase

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https://www.healthwise.net/completecare/Content/CustDocument.aspx?XML=STUB.XML&XSL=CD.FRONTPAGE.XSL

https://www.healthwise.net/completecare/Content/CustDocument.aspx?XML=STUB.XML&XSL=CD.FRONTPAGE.XSL

Provider Responsibilities

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Provider Qualifications

The following provider types may enroll as Child Health Check-Up providers:· Advanced registered nurse practitioners (ARNPs)· Health Maintenance Organizations (HMOs)· Licensed Midwives*· Medical physicians· Osteopathic physicians· Physician assistants

*Licensed midwives are limited to the newborn evaluation only

To provide Child Health Check-Ups, a

provider must be enrolled in Medicaid as a provider with a Category of Service (code 55) for Child Health Check-Ups.

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A Child Health Check-Up provider is responsible for:

Providing or coordinating

all the required

components of the Child

Health Check-Up and

ensuring that the health

screening is conducted in

full accordance

with program regulations;

Ensuring that initial and periodic health

screenings are available

to eligible individuals;

Retaining the required documentati

on of the health

screening in the

recipient's medical record;

Making appropriate referrals and follow-up for

further diagnosis

and treatment of

those problems that the provider

cannot treat;

Offering the recipient

freedom of choice on

direct referrals to

providers for further

diagnosis and

treatment; and

Reporting any evidence of neglect or

suspected child abuse

indicated by the

developmental history or

health screening to the Abuse Registry at

800-342-9152. Providers must

report all supporting evidence.

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CHCUP Tracking Forms

Providers may use the Child Health Check-Up Tracking Form that were designed to capture all required components of the Child Health Check-Up.

Reference optional tracking forms provided in Appendix B of the

Child Health Check-Up Coverage and Limitations Handbook

by clicking on the Handbook above

Use of these forms is optional; however, if a provider does not use

the forms, he or she must still assess and document all the required

components.

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Health Services Responsibilities

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Health Services Team Members Responsibilities

The Health Services team works with the providers and enrollee’s/enrollee’s authorized representatives to ensure that the Child is receiving preventive health screening services.

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Coordination with the member’s PCP

•The Health Services team contacts the PCP through various outreach mechanisms, e.g. telephonic, emails and letters, with a list of members whose periodic screenings are due within the next 30 days.•The PCP’s office staff designee are asked to review the list and call the members who have not scheduled an appointment.•The health guide or ICCM works with the members and PCPs to coordinate services, such as transportation and/or a flexible appointment to ensure the screening is completed.

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Make sure appropriate medical problems are identified during the health screenings and that enrollees are referred to the appropriate medical/behavioral services appropriate to their conditions

Authorize referrals to appropriate providers within four (4) weeks of the

examination for further assessment and treatment of conditions.

Assure appointments are scheduled for a date within six (6) months of the initial

examination.

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Assist the parent in accessing care to obtain fluoride treatment by a physician or a dentist for children/adolescents including fluoride varnish application for children up to four (4) years of age

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•Require all Providers to screen all enrolled children for lead poisoning at twelve (12) and twenty-four (24) months of age as required by the Medicaid Contract •Children/Adolescents between the ages of twenty-four (24) months and seventy-two (72) months of age must receive a screening blood test if there is no record of a previous test •Upon request by a treating Provider, approve additional diagnostic and treatment services determined as medically necessary when an elevated blood lead level is diagnosed•Refer Children/Adolescents who are identified through blood lead screenings as having abnormal lead levels, to receive follow-up services.•Contact the enrollees and providers, through various outreach mechanisms, e.g. telephonic, emails and letters, to ensure follow-up services for Children/ Adolescents diagnosed with an elevated blood lead level.

Contact is conducted monthly until services are completed

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Magellan will approve and process the claims for all CHCUP screenings for children/ adolescents whose enrollment and Medicaid eligibility are undetermined at the time of entry into the care and custody of DCF and who are later determined to be enrollees at the time the examinations took place

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http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://outsidethestoreboughtbox.blogspot.com/2012/04/home-study-approved.html&ei=zPJSVLWsAtShyASxj4G4Dg&bvm=bv.78677474,d.aWw&psig=AFQjCNHIGalIca_Biyhg3_d4WiKsWSUvmg&ust=1414808630107568




Member Outreach and Follow-Up

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Outreach and follow-up

The following outreach methods are acceptable:– Telephonic to assist with appointment

setup, coordination and transportation

– Emails (if permissible by the member/member’s authorized representative)

– Letters (appointment reminders, provider name/telephone number)

Members are contacted systematically over time to promote CHCUP screenings and follow-up

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The health services team will continue to monitor the list to identify members who have not completed their CHCUP health screen and will outreach individuals who: o are due for health screeningso have been on the list for thirty (30) days o are more than two (2) months behind in the periodicity screening schedule

The health services team member will:o engage the member to identify the reason the CHCUP screening was not

completedo provide educational resources about CHCUPo work with the member to remove any barriers to care, o make an appointment with the enrollee’s PCP for a screening visit o offer to assist with scheduling and transportation

All outreach education attempts are documented in the TruCare.

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Make two attempts by

phone at different times

on different days

Set a task in TruCare for follow-up with the member/authorized representative and the provider

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If the member misses an appointment:

•Make at least two (2) attempts to reach the member by telephone at different times on different days•If the staff member is unable to reach the enrollee, send a “Reminder of Need for CHCUP” letter and set a task in TruCare for follow up with the enrollee/ enrollee’s authorized representative•If the enrollee is reached by telephone, assess for barriers to care and assist the enrollee/enrollee’s representative with the barriers and reschedule the appointment

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CHCUP Screen

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Initial Screening: Primary Care Provider

Has your child had a check up with their primary doctor:(FOR CHILD BIRTH THROUGH 23 MONTHS)1a in the last 3 months?Yes (if yes go to #2)No (if no, go to #3) and Can I help

you set up an appointment?

(FOR CHILD 2 yrs and older)1b in the last 12 months?Yes (if yes go to #2)No (if no, go to #3)

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Initial Screening: Immunizations

2. Did your child receive his/her shots during that visit?Yes - do you have a copy of their

records?No - go to #3

3. Has you child received his/her shots from another source e.g. county health department or clinic?Yes - do you have a copy of their

records?No - can I help you set up an

appointment?

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Initial Screening: Lead

4. Has your child ever been tested for lead poisoning?YesNo - can I help you set up an

appointment?

5. Have you ever been told your child has lead poisoning?

Screens should be completed at 12 months and again at 24 months. Children 12 – 72 months must receive a screening test if no record of a previous test

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Initial Screening: Dental Visit

For children over 6 months old:

6. Has your child ever been to a dentist?

7. If so who?

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Documentation and Key Metrics

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The health guide or integrated care case manager will create a Care Coordination Plan goal of Child Health Promotion with the enrollee/enrollee’s authorized representative that reflects individualized enrollee goals and interventions.

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Set and complete follow-up tasks in TruCare to follow-up with the provider and enrollees/enrollee’s authorized representatives

Document all CHUCP appointments and results in Key Metrics

Upload any manually generated educational materials or letters into the document summary and attach them to the case

Letters that are generated through TruCare will automatically show up in the correspondence summary.

Reports are generated monthly to check status and to update Key Metrics and Care Coordination Plan goals as services are completed

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Document all CHUCP appointments and results in Key Metrics

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Questions?

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