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

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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
m. Diagnosis and treatment Y N Y N Y N Y N Y N
n. Referral and follow-up, as appropriate Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
For children/adolescents whom the health plan identified through
blood lead screenings as having abnormal levels of lead, the health
plan provided case management follow-up services as required in
Chapter Two of the Child Health Check-Up Services Coverage and
Limitations Handbook. Screening for lead poisoning is a required
component of the Contract
a. The health plan required all providers to screen all enrolled
children for lead poisoning at ages 12 months and 24
months
b. Children between the ages of 12 months and 72 months
received a screening blood lead test if there was no record
of a previous test
c. The health plan provided additional diagnostic and treatment
services determined to be medically necessary to a child/
adolescent diagnosed with an elevated blood lead level
d. The health plan recommended, but did not required, the use
of paper filter tests as part of the lead screening requirement
The health plan informed enrollees of all testing/screenings due in
accordance with the periodicity schedule specified in the Medicaid
Child Health Check-Up Services Coverage and Limitations Handbook
The health plan contacted enrollees to encourages enrollees to obtain
health assessments and preventive care
The health plan covered fluoride treatments by a physician or a
dentist for children/adolescents even if the health plan does not
provide dental coverage
If the health plan contract covers transportation, the health plan offers
transportation to enrollees in order to assist them to keep, and travel
to, medical appointments. If the contract does not cover
transportation services, the health plan offered to help enrollees
schedule transportation
The CHCU program included the maintenance of a coordinated
system to follow the enrollees through the entire range of screening
and treatment, as well as supplying CHCUP training to medical care
Y N Y N Y N Y N Y N
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N Y N Y N Y N Y N
Y N Y N Y N Y N Y N
Y N Y N Y N Y N Y N
Y N Y N Y N Y N Y N
Y N Y N Y N Y N Y N
Managed Care Organizations Page 2
Child Health Check-Up Policy Checklist F1_04_11
Florida Medicaid