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 ID: 603701
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Presenter's Name, Title, Date, and Location
Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) ProgramSlide2
One of the most valuable tools we have to ensure West Virginia children stay healthy is the HealthCheck model.Slide3
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.Slide4
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.Slide5
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.Slide6
EPSDT ProcessSlide7
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.Slide8
Both an approach to providing comprehensive primary care and a health care setting that facilitates partnerships between individual patients and their personal physicians.Medical HomeSlide9
Periodicity Periodicity refers to the screening intervals recommended by the American Academy of Pediatrics
.Slide10
HealthCheck Screening ServicesSlide11
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.Slide12
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.Slide13
Blood Pressure Blood Pressure should be obtained at 3 years and each periodic screen thereafter.Slide14
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.Slide15
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.Slide16
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.Slide17
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.Slide18
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.Slide19
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.Slide20
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.Slide21
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.Slide22
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.Slide23
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.Slide24
An unclothed comprehensive Physical Exam should be completed at the initial and each periodic screen from birth up to 21 years of age.
Physical ExaminationSlide25
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.Slide26
Immunization Screen Immunization records should be reviewed at the initial and each periodic screen.
Vaccines should be administered when appropriate.Slide27
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.Slide28
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.Slide29
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.Slide30
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.Slide31
HealthCheck Provider Manual The Provider Manual is available on the HealthCheck website.A CD or paper manual is available upon request.
www.dhhr.wv.gov/healthcheckSlide32
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.Slide33
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.Slide34
Billing ALL billing questions:www.wvdhhr.org/bmsMolina
1-888-483-0793Slide35
Thank YouQuestions?