HealthCheck Training
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Post-Test
Overview
Health Supervision
- Introduction
- Health History
- Physical Examination
- Screening Services
- Laboratory Tests
- Immunizations
- Health Education
Special Health Issues
- Introduction
- Dental Health
- Overweight and Obesity
- HIV Guidelines
- Child Abuse & Neglect
- Language Barriers
- Early Intervention
Documentation
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Health Supervision
Introduction: Diagnosis, Treatment, and Referral Requirements
Providing
effective health supervision (as presented in the HealthCheck
Periodicity) helps to ensure that health problems are identified,
diagnosed, and treated early before they become more serious
and the treatment more costly.
Federal EPSDT legislation requires coverage of any services “that are necessary to treat or ameliorate a defect, physical and mental illness or condition identified by a screen.” Such services are allowed under the federal law regardless of whether they are included in the State Plan.
Providers are required to document any well-child screens that result in the need for treatment and/or referral. All HealthCheck treatment should be reported to the MCO or DHCF via claims for fee-for-service members.
Diagnosis
Providers are required to either perform the service indicated or make a prompt and appropriate referral for diagnosis and/or treatment when a physical or behavioral health problem is detected in a health, vision, or hearing screening assessment. Any necessary referrals should be made at the time of preventive health supervision, if possible.
Providers and MCOs must make all reasonable efforts to follow up on referrals for treatment, including referrals made outside the DC Medicaid Managed Care Program, such as mental health referrals. Fee-for-service providers will give the parents or guardian freedom of choice of providers when making a referral. MCOs may limit referrals for covered services to their provider network and should give the parents or guardian freedom of choice of providers when making a referral for non-covered services. All treatment, including referral treatment, should begin within 60 days of the screening.
Treatment
Treatment services include, but are not limited to, the following:
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Referral
Referrals for diagnosis and initial treatment should not be limited solely to services covered by Medicaid or Medicaid-enrolled providers.
All medically necessary services must be provided, whether or not they are covered by DC's State Medicaid Plan.
Referrals must be made to the appropriate provider for diagnosis and treatment for each health finding.
This concludes the Introduction to Health Supervision module. Move on to the next module, Health and Developmental History. |
