The Pennsylvania Department of Human Services (DHS) states that all children enrolled in Pennsylvania's Keystone Health Plan East HMO Children's Health Insurance Program (Keystone HMO CHIP) plan should receive testing for elevated blood lead levels (EBLLs) and developmental screenings as recommended below.
Lead testing and developmental screening recommendations
Practitioners are encouraged to follow the DHS 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 delays using a standardized tool, such as the Ages and Stages questionnaire (CPT® 96110), should be completed for children who are 9 months, 18 months, and 30 months of age, or when surveillance yields concern. The screening should be documented in the patient's chart and included in a claim.
Screening and documentation are especially important for children enrolled in Keystone HMO 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.
Keystone HMO CHIP members should meet the DHS 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 Keystone HMO CHIP members.
Additional well visits
Children who turn 15 months old during the measurement year should receive six or more well-child visits. Children ages 3 to 6 should have one or more well-child visit with their health care provider each year.
What your practice can do
To help ensure your patients receive the required testing, your practice can do the following:
Screen children for EBLLs 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 at 9 months, 18 months, and 30 months of age. Please be sure to document in the member's chart and when submitting the claim or when surveillance yields concern. Examples of validated screening tools for developmental delays can be found on the Bright Futures website:
- Discuss recommendations for lead testing and developmental screening with the parents/guardians of your Keystone HMO CHIP patients.
Identifying Keystone HMO CHIP members
To help your practice easily identify Keystone HMO CHIP members, we include the identifying words “PA Kids" on the front of Independence ID cards, as shown in the sample ID card below.
Reminder: PROMISeTM ID required to render services to Keystone HMO 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 Keystone HMO 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 Keystone HMO CHIP members be registered with DHS as a Keystone HMO 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.
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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 Keystone HMO CHIP members.
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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 Keystone HMO 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:
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