Last year, Independence reminded Keystone Health Plan East practitioners of the importance of testing children enrolled in the Pennsylvania Children?s Health Insurance Program (CHIP) for Elevated Blood Lead Level (EBLL). This year, we again would like to take the opportunity to remind your practice that some of our CHIP population may reside in homes that place them at risk for EBLL. As such, we?re providing you with an update on how your practice can identify CHIP members and continue to evaluate their need for testing.

During 2013, the Pennsylvania Insurance Department reiterated to health plans the importance of increasing rates for lead testing among CHIP members. Independence shared with practitioners the Centers for Disease Control and Prevention?s (CDC) updated recommendation for prevention of lead poisoning and a new reference level of 5?g/dL to identify children and environments associated with lead-exposure hazards.

In accordance with the Pennsylvania Insurance Department and Healthcare Effectiveness Data and Information Set (HEDIS^®) specification, children who are enrolled in CHIP follow the same guidelines for lead testing as children who are enrolled in the Medicaid program; therefore, they should receive at least one lead capillary or venous blood test on or before their second birthday.

Important update: Identifying CHIP members

In December 2014, the parents and guardians of CHIP members received a new Keystone Health Plan East ID card with a new member ID number and instructions to begin using the new cards effective January 1, 2015. To ensure the records of CHIP members are updated and the children receive correct coverage, parents were instructed to use the new ID card each time their children receive medical services and when filling a prescription at the pharmacy.

The new Independence member ID cards still include the identifying words "PA KIDS" written on the front, as shown in the sample CHIP ID card displayed below.

NaviNet^® enhancements

Enhancements are being made to the NaviNet web portal to give providers the ability to identify CHIP members through the PCP CAP Rosters transaction under ePayment.

In the meantime, providers should continue to identify CHIP members by using their ID cards. In addition, a list of CHIP members will also be mailed to Keystone Health Plan East primary care physicians.

Additional information about this enhancement will be provided in future editions of Partners in Health Update. To learn more about changes to NaviNet, we strongly encourage you to review the NaviNet Transaction Changes section of our Business Transformation site, which includes User Guides and a complete archive of communications.

What practices can do: Lead testing vs. screening

Lead testing is described as one or more lead capillary or venous blood test for lead poisoning administered by a child?s second birthday. Lead screening is described as an assessment or questionnaire regarding a child?s health or living environment. While the terminologies are sometimes used interchangeably, lead screening is not the same as lead testing.

Practitioners are asked to test children enrolled in the CHIP program between ages 9 to 12 months, again at 24 months, and thereafter based on risk. All CHIP members should be tested for EBLL regardless of risk level. A risk assessment should be performed starting at 6 months, then again at 9 and 18 months, then annually from ages 3 to 6 with testing as appropriate.

Your personal recommendation has tremendous influence on the parents/guardians of your pediatric patients and their decision to seek lead testing information for their children. Therefore, we respectfully ask for your practice's participation in ensuring that all CHIP members receive lead testing as appropriate.

The following resources provide additional information regarding lead testing recommendations:

• CDC: www.cdc.gov/nceh/lead/nlppw.htm
• Philadelphia Department of Public Health: 215-685-2788 (Philadelphia residents)
• National Lead Information Center: 1-800-424-LEAD (non-Philadelphia residents)
• U.S. Environmental Protection Agency: www.epa.gov

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.