PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

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Appendix E and F Attention-Deficit/ Hyperactivity Disorder (ADHD) CompCare Strategies for Treatment of ADHD 133
RATIONALE: Attention-Deficit/ Hyperactivity Disorder (ADHD) Children naturally show inattention, impulsivity, distractibility and hyperactivity at certain times. True ADHD symptoms present more severely and frequently in effected children than in children of the same age or developmental level. The degree of these symptoms significantly impairs/disrupts academics, peer relationships, family dynamics and social activities. ADHD must begin before age 7 and it can continue into adulthood. ADHD occurs in 3-5% of school age children. ADHD runs in families with about 25% of biological parents having this neurobehavioral condition. GOALS • To ensure proper diagnosis and treatment of ADHD • To address differential diagnoses and co-existing concerns related to ADHD Presenting Symptoms Differential Diagnosis 1. Difficulty Focusing/paying attention 2. Easily distracted 3. Unable to sit still 4. Talks excessively 5. Trouble obeying multiple step commands 6. Always “on the go” 7. Poor organization (loses school supplies, forgets to turn in homework, etc.) 8. Does not finish tasks 9. Fidgets 10. Impatience 11. Disrupted peer relationships Assessment of Symptoms 1. Blood Chemistries (Complete Metabolic Profile, CBC w/ EKG-baseline) 2. History-DX made after thoughtful, detailed history from parent/guardian/primary caregiver regarding above-mentioned symptoms. Symptoms must be present in more than one setting such as school. The symptoms must also manifest at home, church, or in other organized social activities. 3. Standardized Evaluation Forms (behavior rating scales)-should also be used to support the diagnosis. These scales can be completed by parents, teachers, coaches, etc. A child who “keeps it together” in the office of a clinician should not be assumed to be free of a DX of ADHD. 1. Sudden life changing event 2. Seizure disorder 3. Middle ear disease 4. Underachieving because of learning disability 5. Anxiety/depression 6. Medical disorder affecting brain functioning 7. Medication side effect Note: All that is inattentive/fidgets is not ADHD Co-Existing Psychiatric Concerns 1. Low self-esteem 2. Depression 3. Anxiety 4. Conduct issues 5. Substance abuse 6. Active physical/sexual abuse 7. Risky, dangerous behavior (self harm, aggression toward others) Treatment • Medication has clearly demonstrated an ability to improve attention, focus, goal directed behavior Methylphenidate and amphetamine preparations and non-stimulant: atomexetine. Others such as guanfacine, clonidine and some other antidepressants may also be helpful. • Non medication treatments should ALWAYS be considered. These treatments consist of social skills training, parent education, modifications to child’s education program, behavioral therapy, cognitive therapy, activity recreational therapy, and supportive psychotherapy. Author Rahul Mehra, MD, Board Certified Child and Adolescent Psychiatry, 2004 (For Comprehensive Behavioral Care, <strong>Inc</strong>.) 134
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Parkland KIDSfirst, Parkland CHIP P
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Notification of Change in Provider
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CLAIMS SUBMISSION .................
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Quick Reference Checklist This manu
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Plan specified services. However, c
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CHIP Covered Services PCHP provides
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• Surgical implants • Other art
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Outpatient Mental Health Services I
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• Out-of-network services not aut
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CHIP Perinatal Covered Services Cov
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15 Covered Benefit CHIP Perinate Ne
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Covered Benefit CHIP Perinate Newbo
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• Personal comfort items includin
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• Donor non-medical expenses •
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SUPPLIES COVERED EXCLUDED COMMENTS/
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SUPPLIES COVERED EXCLUDED COMMENTS/
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Coordination between Physical and B
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in the provision of care and servic
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statement indicating that members s
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As the Primary Care Provider you mu
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Other Access Standards Service Stan
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Members Right to Select Network Oph
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HMO/Provider Coordination PCHP will
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45 • describe the range of medica
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Coordination of Care The Primary Ca
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Coordination with Texas Department
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Presentation at Emergency Room afte
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If the complaint is received verbal
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Expedited Appeal can be made verbal
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CHIP Eligibility CHIP KidsFirst Mem
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• Information concerning the grie
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Parkland Community Health Plan Memb
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Pregnant Teens Please call Parkland
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your income. Co-payments do not app
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Member’s Right to Designate an OB
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70 To report providers use this add
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5. Network providers must report an
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To request to be a Specialist servi
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• OB/Gyn • Periodic Health Chec
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The table below provides HHSC Manag
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CHIP Cost Sharing Caps Members rece
Page 89 and 90: of these two dates: July 18, 2007,
Page 91 and 92: (DD) Diagnosis code by specific ser
Page 93 and 94: (PP) Attending physician ID (UB-04,
Page 95 and 96: (2) post-partum visits within 60 da
Page 97 and 98: CHIP Member Enrollment and Disenrol
Page 99 and 100: • In order to synchronize all CHI
Page 101 and 102: Provider Participation Requirements
Page 103 and 104: • Evidence of state licensure, an
Page 105 and 106: U1 U2 U3 Medically necessary delive
Page 107 and 108: PROCEDURE DESCRIPTION PROCEDURE COD
Page 109 and 110: provider actually treating the memb
Page 111 and 112: themselves appropriately and follow
Page 113 and 114: Medical Record Standards The medica
Page 115 and 116: 1. History and Physical Examination
Page 117 and 118: WIC services include providing nutr
Page 119 and 120: As soon as the member knows they wi
Page 121 and 122: 3) by the director to the employee
Page 123 and 124: In addition to the previously state
Page 125 and 126: Prior Authorization The CHIP Perina
Page 127 and 128: Appendix A Universal Referral/Prior
Page 129 and 130: Appendix B Consent for Disclosure 1
Page 131 and 132: PERMISSION TO RELEASE CONFIDENTIAL
Page 133 and 134: EXAMPLE FORM PRIVATE PAY AGREEMENT
Page 135 and 136: Appendix D Clinical Practice Guidel
Page 137 and 138: Appendix D - Continued Clinical Pra
Page 139: Appendix D - Continued Clinical Pra
Page 143 and 144: Appendix G Urinary Tract Infections
Page 145 and 146: Follow-up • Follow-up urine cultu
Page 147 and 148: RATIONALE: Prevention of RSV Illnes
Page 149 and 150: RATIONALE: Treatment of Group A Str
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