The Pennsylvania Department of Human Services (DHS) and Healthcare
Effectiveness Data and Information Set (HEDIS®) specifications
state that all children enrolled in Pennsylvania's Children's Health Insurance
Program (CHIP) should receive testing for elevated blood lead levels (EBLL) and
developmental screening as recommended below.
Lead testing and developmental screening
recommendations
Practitioners are encouraged to follow the Medicaid and Bright
FuturesTM guidelines for lead testing and developmental
screening. A lead blood test should be completed at ages 9 to 12 months and
again by age 24 months. Formal screening for developmental disorders using a
standardized tool, such as the Ages and Stages questionnaire
(CPT® 96110), should be completed for children who turn 1,
2, or 3 years of age or when surveillance yields concern. This is especially
important for children enrolled in CHIP because of the higher incidence of
developmental delay among certain pediatric populations enrolled in
government-sponsored programs when compared to children enrolled in privately
insured plans.
CHIP members should meet the Medicaid guidelines for lead testing and
developmental screening regardless of risk level. We know many provider
practices have already performed these tests, and we thank you and your staff
for the care you provide to our pediatric and CHIP members.
What your practice can do
To help ensure your members receive the required testing, your practice can
do the following:
- Screen children for EBLL by performing a risk assessment at 6 months, 9
months, 18 months, and then annually from ages 3 – 6, with testing as
appropriate.
- Perform developmental surveillance at each well-child visit and document
the use of a standardized developmental screening tool for children who turn 1,
2, or 3 years of age or when surveillance yields concern. Examples of validated
screening tools for developmental delays can be found on the DHS website.
- Discuss recommendations for lead testing and developmental screening with
the parents/guardians of your CHIP patients.
Identifying CHIP members
To help your practice easily identify CHIP members, we include the
identifying words “PA Kids” on the front of Independence ID cards,
as shown in the sample CHIP ID card below.
Reminder:
PROMISeTM ID required to render services to CHIP
members
The state of Pennsylvania requires a Provider Reimbursement and Operations
Management Information System (PROMISe) ID for all providers who
render, order, prescribe, or bill for items or services to CHIP members. There
are a few important things about PROMISe IDs to keep in mind:
- DHS implemented the Affordable Care Act provision that requires all
providers who render, order, prescribe, or bill for items or services to CHIP
members be registered with DHS as a CHIP provider at each provider
location.
- Upon acceptance, DHS will issue providers a
PROMISe identification number for each
location.
- Remember, obtaining a PROMISe ID
does not mean providers must accept Medical
Assistance beneficiaries.
- As of July 1, 2019, a PROMISe ID is required
for providers to receive payment from Independence for services or items
rendered, ordered, prescribed, or billed for CHIP members.
- As of July 1, 2019, claims submitted to Keystone Health
Plan East by a provider who does not have a PROMISe ID at the location
where services or items were rendered, ordered, prescribed, or billed for CHIP
members will not receive payment.
- Visit the DHS website to access the application,
requirements, and step-by-step instructions related to the enrollment
process.
Resources
The following resources provide additional information regarding lead
testing and developmental screening recommendations:
HEDIS is a registered trademark of the National Committee
for Quality Assurance (NCQA). Used with permission.
CPT Copyright 2017 American Medical Association. All
rights reserved. CPT® is a registered trademark of the
American Medical Association.