Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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1
Agency For Health Care Administration
Managed Care Organizations
Child Health Check-Up Policy Checklist
REQUIREMENTS FOR CHILD HEALTH CHECK-UP
Required Components File #1 File #2 File #3 File #4 File #5
Comprehensive health and developmental history including:
Y N Y N Y N Y N Y N
a. Past medical history Y N Y N Y N Y N Y N
b. Developmental history Y N Y N Y N Y N Y N
c. Behavioral health status Y N Y N Y N Y N Y N
d. Comprehensive unclothed physical examination Y N Y N Y N Y N Y N
e. Developmental assessment Y N Y N Y N Y N Y N
f. Nutritional assessment Y N Y N Y N Y N Y N
g. Immunizations according to the Recommended Childhood
Immunizations Schedule for the United States
Y N Y N Y N Y N Y N
h. Health education/anticipatory guidance Y N Y N Y N Y N Y N
i. Dental screening Y N Y N Y N Y N Y N
j. A direct referral to a dentist for enrollees beginning at age
three or earlier as indicated
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
k. Vision screening, including objective testing as required Y N Y N Y N Y N Y N
l. Hearing screening included objective testing as required Y N Y N Y N Y N Y N
Managed Care Organizations Page 1
Child Health Check-Up Policy Checklist F1_04_11
Florida Medicaid