Presenter's Name, Title, Date, and Location Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) Program

One of the most valuable tools we have to ensure West Virginia children stay healthy is the HealthCheck model.

What is HealthCheck? Pediatric preventive health program for Medicaid eligible children and youth up to 21 years of age. West Virginia’s federally mandated EPSDT Program.

What is EPSDT? Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) is a federally mandated comprehensive health care benefit package for Medicaid enrolled individuals under the age of 21. The primary emphasis of EPSDT is preventive care.

EPSDT Acronym The first three letters of EPSDT refer to the fact that eligible children are entitled to regular comprehensive assessments of their health, or Early Periodic Screening. The last two letters of EPSDT are triggered by the health screenings. Once a child is seen by his or her provider and a screen reveals a problem, a Diagnosis is made and medically necessary Treatment can be provided.

EPS Initial Screen (First Checkup) Periodic Screen (Regular Checkup) Interperiodic Screen (Other visit to medical provider) D Provider makes Diagnosis T Medically necessary Treatment is provided EPSDT Process

Bright Futures Bright Futures Bright Futures is a set of principles, strategies, and tools that are theory based, evidence driven, and systems oriented that can be used to improve the health and well-being of all children.

Both an approach to providing comprehensive primary care and a health care setting that facilitates partnerships between individual patients and their personal physicians. Medical Home

Periodicity Periodicity refers to the screening intervals recommended by the American Academy of Pediatrics.American Academy of Pediatrics.

HealthCheck Screening Services

Health and Medical History A comprehensive Health and Medical History should be completed during the child’s initial screen. The initial Health and Medical History information should be reviewed and updated at each periodic screen.

Growth Measurements Height and Weight should be plotted on a growth chart at the initial and each periodic screen. Head Circumference should be plotted on a growth chart from birth to 2 years of age. Body Mass Index (BMI) should be calculated and plotted on a BMI chart at the initial and each periodic screen beginning at age 2 through 21 years of age.

Blood Pressure Blood Pressure should be obtained at 3 years and each periodic screen thereafter.

Tuberculosis (TB) Risk Screen A Tuberculosis Risk Screen should be completed at the following ages: 1 month, 6 months, and every year beginning at 12 months up to 21 years. If a child is identified as high risk, further TB screening protocol as set forth by the WV TB Program should be initiated.

Lead Risk Screen A Lead Risk Screen should be completed at the initial and each periodic screen beginning at 6 months through 6 years of age. A Serum Lead Test should be completed at 12 and 24 months and up to 72 months if the child has never been screened.

Dyslipidemia Risk Screen A Dyslipidemia Risk Screen should be completed at the following ages: 2 years, 4 years, 6 years, 8 years, 10 years and every year beginning at 11 years up to 21 years. A Fasting Lipid Profile should be obtained when one or more risk factors indicate high risk.

Developmental Surveillance Developmental Surveillance is a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care. Developmental Surveillance should be completed at the initial and each periodic screen.

Developmental Screen A Developmental Screen, via a standardized screening tool, should be completed at the following ages: 9 months, 18 months and 30 months. Additional developmental screening, via administration of a standardized screening tool, may be conducted anytime caregiver or primary care provider concerns are identified.

Autism Screen Autism Surveillance should be completed at the initial and each periodic screen. An Autism Specific Screen should be completed at 18 and 24 months or at any other time a concern arises.

Psychosocial/Behavioral A Psychosocial/Behavioral Assessment should be completed at the initial and each periodic screen from 0 years up to 21 years of age. An Alcohol and Drug Use Assessment should be completed at the initial and each periodic screen beginning at 11 years of age.

Vision Screen A Vision Screen should be completed at the initial and each periodic screen. An Objective Vision Screen should be completed at the following ages: 3, 4, 5, 6, 8, 10, 12, 15, and 18 years. A Subjective Vision Screen should be completed at the initial and each periodic screen when an objective screening is not completed.

Hearing Screen A Hearing Screen should be completed at the initial and each periodic screen. An Objective Screen should be completed at the following ages: birth, 4, 5, 6, 8 and 10 years. A Subjective Hearing Screen should be completed at the initial and each periodic screen when an objective screening is not performed.

Oral Health Screen An Oral Health Screen should be completed at the initial and each periodic screen to determine the presence of any current dental problems, date of last dental visit, and availability of fluoride in the water. Every child should either be under the care of a dentist or referred to a dentist by 12 months of age.

An unclothed comprehensive Physical Exam should be completed at the initial and each periodic screen from birth up to 21 years of age. Physical Examination

Health Education Health Education, including age appropriate anticipatory guidance, is to be provided at the initial and each periodic screen from birth up to 21 years of age.

Immunization Screen Immunization records should be reviewed at the initial and each periodic screen. Vaccines should be administered when appropriate.

Laboratory Tests Every child should have a Newborn Metabolic Screening completed. A Hemoglobin/Hematocrit should be completed at the 12 month screen. A Fasting Lipoprotein should be completed at 20 years of age.

Laboratory - Lead A Blood Lead Level should be completed at 12 months of age, 24 months of age & 36 months to 72 months if child has never been screened. A referral should be made if blood lead level is = or > 10 to the WV Childhood Lead Poisoning Prevention Program.

Referrals & Documentation When a screen indicates the need for further evaluation, a referral should be made to the appropriate provider. For children who require a service beyond the benefit package limitations, the primary care provider must have documented the medical necessity for the service during the provision of EPSDT screening services.

WV Kids First All children entering school for the first time in the state of WV should have a well child screen following the HealthCheck protocol outlined on each age appropriate screening form.

HealthCheck Provider Manual The Provider Manual is available on the HealthCheck website. A CD or paper manual is available upon request.

Preventive Health Screen Forms The Preventive Health Screening Forms are available on the HealthCheck website. Providers have the option of using their own screening forms or electronic medical records.

Program Specialists The HealthCheck Program Specialists focus on equipping Medicaid providers with the necessary tools and knowledge to carry out EPSDT screening services that meet reasonable standards of medical practice.

Billing ALL billing questions: Molina

Thank You Questions?