thank you for listening in on the
Child and Teen Checkups periodicity
schedule updates for October 1st 2017
the purpose of this recording is to
provide some updated clarifications and
new resources for clinics that are
implementing the updated schedule which
went into place on October 1st 2017 so
the focus of this webinar is on the
clinical aspects although there's a
brief mention of billing at the end of
the recording the Minnesota Department
of Human Services is our state Medicaid
agency and as the agency that creates
Child and Teen Checkups policy so this
MHCP provider manual C&TC section
online is your go-to place for full
policy information related to Child and
Teen Checkups and that is updated with
the current requirements this is where
you find billing and coding information
as well if you don't find what you're
looking for there or you need to contact
someone at DHS regarding Child and
Teen Checkup so you can either use the
email or the phone that are listed there
the Minnesota Department of Health
provides health consultation and
training and so the MDH Child and Teen
Checkups website has clinical resources
for each of the screening components and
the preventive services that are part of
Child and Teen Checkups so for example
that's where you will find fact sheets
for each of the screening components and
in those fact sheets it'll state what
is specifically required in terms of
meeting that screening component and
what is required for documentation when
you go to the MDH Child and Teen
Checkups website if you look on the
right side and the spotlight area it has
recently added resources and on the left
navigation panel you'll find a link to
get to the fact sheets as well as
information for providers which may be the
most important spot on the MDH website
for providers and clinics it will link
you not only to the current C&TC
periodicity schedule but it also lists
resources for each of the screening
components some new resources are now
listed here under developmental
mental health screening there's a full
list of recommended tools that are
commonly used in primary care settings
both for developmental screening of
young children and social emotional and
mental health screening for birth
through 20 years of ages as well as
maternal depression screening under
laboratory tests and risk assessment
there are a couple of new items
specifically designed to help clinics
with implementation of the universal HIV
screening component for example there's
a letter template that clinics can use
and revise to share information with
families about confidential services
that are part of every visit starting at
about age 11 so this allows clinics to
explain the importance of having
one-to-one time with the child and the
provider beginning in early adolescence
not only to help that child kind of
develop an a sense of their own health
and take charge of their own health but
also to address some of the confidential
services that are protected under
Minnesota's minor consent statute
there's also an HIV FAQ or frequently
asked questions sheet that clinics
can use to help explain to families in
youth why the universal HIV test is
being offered to everyone at least once
between fifteen and eighteen years of
age and with that FAQ it's recommended
that clinics can revise the introductory
paragraph but it's recommended that they
leave the bulleted points as written
because they're vetted
it's vetted and evidence-based
information from the CDC and the
Minnesota Department of Health
STD program the updates of the Child and
Teen Checkups schedule just in review
are essentially based on the American
Academy of Pediatrics or AAP or Bright
Futures guidelines and these were most
recently updated in spring of 2017 so
where the child and teen checkups did
not already align with a Bright Future's
schedule those changes were made in many
cases and there are some new
recommendations from Bright Futures that
were added to the child and teen checkup
schedule so in some cases we were
catching up to previous changes and in
other cases there were new
recommendations that we had to consider
when we look at the Bright Futures we
also look at it through the lens of the
United States Preventive services task
force because they do a review of the
evidence base for various preventive
services and so if they have a grade A
or B recommendation for that screening
service it's more likely to be reflected
in the child and teen checkups
periodicity schedule we also pay
attention to other national
recommendations and
guidelines especially from the Centers
for Disease Control and Prevention or
the CDC for example as it relates to
immunizations, tuberculosis, and early
childhood development for the most part
Child and Teen Checkups guidelines also
align with Minnesota Community
Measurement Guidelines and the required
clinical reporting that clinics do
across the state for pediatric
preventive care I will make mention a
little bit later on our mental health
screening where there's a caveat and a
slight difference between Child and Teen
Checkups and that measure and finally of
course in addition to all these
guidelines we have to pay attention to
the health data for our specific
population that Child and Teen Theckups
is serving which is children birth
through 20 years of age who are eligible
for Medicaid and Minnesota Care as a
part of the process in updating the
Child and Teen Checkups schedule DHS
and MDH also met with and
requested input from the Minnesota
Academies of Pediatrics, Family Medicine,
and Pediatric Nurse Practitioners as
well as clinician representatives
regarding these changes here is the
updated Child and Teen Checkups schedule
effective October 1st we will discuss in
this recording all the changes to the
schedule just want to point out a couple
of things about the new schedule one is
that it's larger in size it's legal size
to accommodate the additional visits
particularly the annual visits in middle
childhood and adolescence which is
consistent with long-standing Bright
Futures guidelines if you look at the
schedule in the upper left-hand corner
there's a hyperlink to the fact sheets
and as I said there's a fact sheet for
each component so that's an important
resource both for clinicians as well as
for coders who are helping with the
documentation piece in the left-hand
column where each of the screening
components is
an asterisk indicates that it's a new
requirement and more information for
each of those items is available on the
back of the schedule other symbols are
the same as on the schedule that was
previously posted in 2016 and the key at
the bottom indicates what each of the
symbols means a bullet point or a dot
indicates are required screening or
preventive service for that visit an R
indicates a screening that is strongly
recommended but not required
and arrows indicate arrange that the
screening as a particular screening can
be done and you'll see it there for a
couple of different components a set of
arrows from one age to another indicates
that the screening should be provided at
least once in that age range so an
example is a screening hemoglobin test
at least once for menstruating females
in general screening earlier in that
time range is probably preferred in case
the patient misses future recommended
Child and Teen Checkups of visits
however in some cases it might be better
to wait based on other medical or
individual factors an example would be
if an adolescent female just begin
menstruating 1 or 2 months ago it might
be better to wait until their next Child
and Teen Checkups visit to do that
screening hemoglobin for anemia as I
mentioned one of the major changes to
the schedule is increased frequency of
visits which now aligns with the Bright
Futures schedule so the first addition
to visits is the 30 month or two and a
half year visit this is a really
critical time for early childhood brain
development I think we're all aware of
that the advantage of having a 30 month
visit is that in that time of incredible
development not just bring brain
development also physical development
it's important time an opportunity to
get in screenings that may have been
missed previously and we can spread out
the various recommended screenings
including developmental social-emotional
and autism in Minnesota and some studies
that were done in 2015
our average age of diagnosis for autism
was about five years of age and we know
that we can reduce that to closer to two
years of age if we're able to get in
standardized screening anticipatory
guidance is also a really important part
of each visit and particularly in this
age group to help support healthy
development it's also an opportunity to
catch up on lead or other screenings
if the child is behind on that the
other change in frequency is moving from
every two years to annual visits
from six to twenty years of age for a
long time the Bright Futures guidance
has been to provide annual visits in
this age range and so now with this
schedule we are aligning with that
recommendation
we know that for Child and Teen Checkups
and this is true across the nation not
just in Minnesota but rates of
well-child visits get lower and lower
once a child gets through elementary
school we also know that when a
healthcare provider emphasizes to
families that these preventive visits
are important and why that's what makes
families and children more likely to
come in for those annual visits so that
messaging is really important health
plans and Child's and Teen Checkups
coordinators and outreach staff also
play a really important role in
encouraging and supporting more regular
Child and Teen Checkups work is going on
at the state level to especially focus
on adolescents and young adults to help
increase those preventive visits and the
reason for that is that this as you know
is a really important time for
development it's a really great time for
developing strengths and resilience but
it's also a time of risk taking an
important time to help prevent and
identify early any risks for obesity
relating related conditions mental
health issues or other things that tend
to emerge during this age range it's
also a great time to help young people
establish independence and take charge
of their own health
on the backside of the periodicity
schedule we just mentioned that the AAP
recommends that children and youth who
are in foster care or out of home
placement should receive well visits
twice as often as are listed on the
schedule and this is because they're at
the highest risk really for both
physical health mental health and
developmental concerns as a result of
the trauma or neglect that they've
experienced the first link that's listed
here under resources brings you to the
American Academy of Pediatrics Healthy
Foster Care America and that's where
you'll find a variety of guidelines and
other supports around care for children
and youth in foster care the second link
brings you to a health information form
that provides guidelines about what
specifically should be done at the
different ages and some suggestions for
documentation so this is a
representation of the several more major
clinical changes that are part of the
new periodicity schedule and so with
this recording we'll proceed through
each of these one by one I'll spend a
little bit more time on some than others
because some of these are more
challenging than others for clinics to
implement and remember each of these
components does have its own fact sheet
that goes into more detail and includes
documentation requirements so first
we'll talk about weight for length
percentile many if not most clinics are
already doing this but just like we do
BMI starting at 2 we really want to pay
attention to their weight for length
percentile in an infancy and toddlerhood
to make sure that their growth is coming
along well make sure that they're not
underweight or overweight and if there
are concerns about feeding or growth we
want to make sure that children are
getting the resources that they need
every child that's eligible for Child
and Teen Checkups should be referred to
WIC for food support and nutritional
counseling but for infants and toddlers
with excessively low or high weight for
length percentile
this is especially important the nice
thing is that in the electronic health
record that you're using it probably is
capable of calculating that percentile
for you and so for the provider it's
just a matter of taking a look at that
growth chart
the patterns of growth over time and
responding to those appropriately and
for those that are using paper charts
are not using an EMR or just want
another way to look at this there's a
link directly to the clinical growth
charts from WHO or the World Health
Organization that are appropriate for
infants and toddlers on the CDC website
the second component that we'll discuss
is mental health screening and this has
been previously recommended for Child
and Teen Checkups and in fact clinics
around the state have been reporting on
this already as a clinical quality
measure with Minnesota Community
Measurement for the last couple of years
in fact the screening in Minnesota by
the end of 2016 was already over 70
percent and there's still some
disparities in terms of how often youth
are getting this screening
at their well visit and there's more
variation in there an urban or sorry in
rural areas than in urban areas and that
may relate also to some concerns about
access to referral resources but we'll
talk about that as well and so in line
with the AAP US Preventive Services Task
Force and Minnesota Community
Measurement standards mental health or
depression screening for youth 12 and
older is now required for a Child and
Teen Checkups so in order to be able to
build for that enhanced bundled rate for
a complete Child and Teen Checkup mental
health screening is now required and in
order to meet that requirement you need
to use a standardized screening
instrument the mental health screening
fact sheet lists recommended tools and
referral resources and I want to
highlight a couple of resources around
both of those issues first there's a
list and then a more detailed comparison
table of recommended standardized mental
health screening instruments for Child
and Teen Checkups at the link that is on
this slide and you can download download
the slides separately from the website
where you found this webinar recording
there's also a list and a map of
agencies around the state that provides
school linked mental health services
not every school district in the
state has school linked mental health
services but many do and currently tens
of thousands of young kids err sorry
young young people adolescents and
school-age kids are receiving mental
health services through the school
other resource options more and more
health systems are working on expanding
their mental health resources either
integrated directly into primary care or
at least within the health system and
then there are many agencies in every
county around the state that provide
mental health services not just for
adolescents but also for very young
children and their and their families so
the key question that has come up around
mental health screening since the
implementation of the new schedule is
the fact that the PHQ-2
depression screener is listed for
Minnesota Community Measurement quality
improvement reporting standards as not
strongly recommended but acceptable so
many clinics or health systems around
the state have been using the PHQ-2 as
their first line Universal screening for
mental health however that tool is not
yet recommended for Child and Teen
Checkups and the reason for that is that
at the last review that was done of that
tool looking at psychometric properties
it did not meet basic standards for
reliability in the adolescent population
and that tool is currently under re-
review and so when more information is
available about that we will make sure
that that information gets out so
meanwhile it's the PHQ-9 that is a
recommended tool but there are others as
well for example the Pediatric Symptom
Checklist and several others which you
can find listed either just on a plain
list or in much more detail at the
hyperlinks that are listed on this slide
the next change is the addition of
universal HIV screening for adolescents
and this I think has been probably the
most challenging for clinics around the
state and partly because it's a new
practice and partly because there are
lots of questions around communicating
with families and young people about
this requirement so this is not a new
recommend recommendation from Bright
Futures it's been on their
guidelines for a number of years now
it's been recommended both by the CDC
and the US Preventive Services Task
Force but it not until this year did we
have the information and the
recommendation from the MDH STD
program that Minnesota HIV prevalence
data does meet the criteria or the
threshold for implementing this routine
Universal HIV screening of all youth at
least once in this age range so 15 to 18
years of age and this is regardless of
whether they say they're sexually active
or not the child linking checkups
schedule has in the past already
included STI risk assessment so HIV risk
assessment should already be a standard
part of clinics practices however the
difference with this is instead of just
limiting HIV screening to youth who have
meet specific risk factor criteria the
recommendation again is to offer this
screening at least once to every young
person from 15 to 18 years of age there
are several things you'll want to
consider as you're implementing this
first of all communication with parents
and young people is important and so
that letter template that I mentioned
earlier which is available on the MDH
Child and Teen Checkups website under
provider information that template can
be useful to explain the concept of
confidential care within the system and
the HIV FAQ is a helpful resource to
explain why the HIV testing is being
offered so simply making families aware
that this is a universal recommendation
that's going out not just in Minnesota
but elsewhere is helpful in reducing
some of the angst that might come
up around billing questions or other
confidentiality issues
speaking of confidentiality it's important
to be clear that HIV testing is covered
under Minnesota's minor's consent statute
so when the provider is talking to the
patient the adolescent or young adult
patient about HIV testing and STI risk
assessment this should be done in a
private confidential conversation
one-to-one with the patient and so the
decision around HIV testing or other
testing in this case as it relates to
prevention of STDs or early
identification and treatment of STDs
this is a decision made by the young
person so if a test is declined that is
the young person's decision it's not the
parent or guardian decision and likewise
the results of the test should be
confidential and communicated only
and directly to the young person unless
the patient explicitly gives permission
for that information to be shared with
their parent or guardian as with any
screening clinics will need to be
prepared for further evaluation and
treatment if screening results are
positive and the CDC and the MDH website
offer clear resources about that so a
few resources for you to consider number
one is the the fact sheet again that's
available on the MDH website for HIV
testing the cdc has a fairly extensive
HIV testing website and then there are
links here to that HIV FAQ and parent
confidentiality letter template so again
when you go to the C&TC
information for providers web page
scroll down to screening components and
you'll find these two resources
available under laboratory testing also
listed on the fact sheet are some
training resources that are available
for free from MDH and again if you have
questions about this please feel free to
email or call MDH for some help with
implementing this piece for Medicaid
parents will not receive an Explanation
of Benefits or billing information about
this confidential service some clinics
have expressed concerns that private
insurers
do not follow that same practice and in
some cases that may be true and so this
is something that we're also looking at
at a state level and that Minnesota
health plans have been discussing as
well so hopefully we'll have some
updates to offer around that as well in
the future dyslipidemia risk assessment
has some caveats that I'd like to
discuss lipids previously were on the
Child and Teen Checkup schedule but they
were just mentioned under under other
labs as medically indicated so the
purpose on the new schedule and fact
sheet for dyslipidemia is to really
clarify what is recommended for that
this is an example where we actually
differ from the Bright Futures schedule
the American Academy of Pediatrics
recommends that every child get a blood
test for dyslipidemia once at nine to
eleven years and once at 17 to 21 years
however the US Preventive Services Task
Force found insufficient evidence for
this universal blood testing and so
based on that and several other factors
the requirement for Child and Teen
Checkups is simply that a risk
assessment be done at the ages that are
indicated on the schedule and those ages
aligned with the AAP recommendations as
well for a risk assessment so age two
years, four, six, eight, eight years and
then there are a few times again through
nine to twenty years in terms of how
that risk assessment looks this is
something that your clinics are likely
already doing it involves a combination
of a family history and looking at the
child's indicators on that day their BMI,
their tobacco use, and their blood
pressure if you refer to the new dys
lipedema a risk assessment fact sheet in
the link directly to the PDF is there
you'll see that those risk factors
particularly the family history risk
factors are specifically listed out so
you'll just want to check and make sure
that those are covered in your
comprehensive or interim health history
and finally in terms of all the details
on treatment and testing and how that
works all that information is available
from the expert
integrated guidelines for cardiovascular
health and risk reduction and children
and adolescents so there's a link to
that extensive document there in terms
of documentation if you look at the fact
sheet it says that's what's required is
that the child and teen checkups visit
records show that a dyslipidemia risk
assessment was done and that it's been
acted on appropriately there's some minor
changes on vision screening it's
actually just a clarification because
the recommendation came out previously
in 2015 that children not only get
distance vision screening with the
ten-foot wall chart but that they also
get near visual acuity using the plus
lens screening and so the clarification
for the new periodicity schedule which
was implemented on October 1st is that
this plus lens screening is required as
a part of the required vision screening
at the ages that are indicated on the on
the schedule and so this is based on
national recommendations as well as a
Minnesota expert panel that included
ophthalmologists, optometrists, and other
and screening providers the plus lens
screening itself is inexpensive and it's a
very quick way to identify children with
near vision problems before they run
into academic problems which is very
common particularly in the Medicaid
population so while the child is still
standing at the visit distance vision
chart 10 feet away from that chart if
they are 5 years of age and older and
do not already have prescription lunges
lenses and they passed their distance
vision screening those children then
should do the near visual acuity
screening with the plus lens so for
those kids that are 5 and older who
don't already have glasses and pass
their distance screening you just put
the plus lens or readers or cheater
glasses on them use a 2.5 plus lens and
have them look with both eyes just at
the line that they passed on their
distance vision screening if they can
see that line clearly that's a problem
because you just put cheaters on them so
it should be blurry so the kids if they
can see the line clearly they should
actually be referred
and to see an eye doctor if they can't see it
well that's a good sign and they've
passed the plus lens screening so it's
from we've heard from clinics it's very
quick it takes maybe 15 to 30 seconds to
add this piece on to the vision
screening the procedure is laid out step
by step in the vision screening manual
and the link is there and there's also a
vision screening e-learning module if
that would be helpful for your clinic
staff but I think your most important
resources that vision screening manual
where the procedures are laid out in
detail I want to add a separate note
about instrument based screening or
using those automatic screening
instruments the current recommendation
is that these instruments can be used
for children who are unable or unwilling
to cooperate with routine visual acuity
screening using the ten-foot wall chart
so the wall charts are still the goldens
gold standard photo screening and
handheld auto refraction may be used as
an alternative to visual acuity
screening with vision charts for kids
that are 3 to 5 years of age but
currently instrument based vision
screening is not recommended for
children older than 6 years of age who
can be screened using the traditional
visual acuity charts for hearing
screening hearing screening has always
been required for Child and Teen
Checkups at certain ages and so the
difference now is that for children 11
years of age and older
clinics should add high frequency
screening adding the 6,000 Hertz
screening level at 20 decibels to their
routine puretone audiometry screening
and this is to identify children who may
have noise induced hearing loss there's
a slight difference in the requirement
for Child and Teen Checkups compared to
the AAP recommendations the AAP
recommended adding both 6,000 and 8,000
Hertz
however on further research we found
that just using the 6,000 Hertz level
will essentially catch the same number
of children who may have noise induced
hearing loss and it's much easier to do
in your average clinical setting where
you don't have a sound-proof
booth for hearing screening so in the
past you've always done 5,000 or sorry
500 Hertz at 25 decibels and then you've
screened one thousand, two thousand, and
four thousand Hertz at 20 decibels
so beginning at eleven years of age
you'll just add to six thousand Hertz
level at 20 decibels one challenge is
that many clinics have been using
hand-held audiometers that do not
provide this full range of screening
recommended audiometers can provide the
full range and actually 250 through
8,000 Hertz and recommended audiometers
also can do manual and not just
automatic puretone screening ideally
with headphones instead of the handheld
ear apparatus to ensure that the
screening environment is quiet enough to
do that both the 500 and the 6,000 Hertz
it's recommended that clinics do an
environmental noise level check first
and there's a link there to the
procedure to do that but essentially
what you do is just in order to test
your screening environment to make sure
it's not too noisy you just have someone
one of your staff people who has normal
hearing go in the room with the audi-
ometer and check they should be able to
hear all the screening frequencies five
hundred, a thousand, two thousand, four
thousand, and six thousand Hertz at ten
decibels below what they're screening
children for so in other words when
you're doing this environmental noise
check you should be able to hear the
five hundred Hertz level at 15 decibels
and then the other higher levels at ten
decibels that's your way of checking to
make sure that your screening is going
to work what we've heard from people is
that before they try doing this
environmental noise check they were
getting a lot of false positives and
when they checked it and they adjusted
their environment to make sure that they
were you know you don't want to be in
the same room as the vaccine
refrigerator that's humming in the
background for example they found that
when they were in an appropriately quiet
screening environment they were able to
catch kids who actually had issues and
and the kids that they caught with high
dust high frequency screen loss where
kids
I had a history of hunting or wearing a
band or something similar so that's just
an example of stories that we've heard
from clinics who are implementing all
right so fluoride varnish has been on
the child and teen checkups schedule
previously it's strongly recommended by
the AAP and US Preventive Services Task
Force as well as other national dental
bodies but as of October first fluoride
varnish for fluoride varnish application
is actually required at every Child in
Teen Checkups a visit from the eruption
of the first tooth through five years of
age flouride varnish is very effective and
it's a passive preventive measure that's
primary care providers can do to prevent
dental decay in young children and
dental caries are actually the number
one infectious disease in pediatrics
it's one of the top reasons that
children end up missing school or having
having to go under general anesthesia
and so with dental caries being entirely
preventable we want to make sure that
children who are Medicaid eligible in
Minnesota who are at higher risk for
caries are actually getting fluoride
varnish in addition to being at higher
risk for dental caries kids who are
Medicaid eligible especially young
children have real challenges around
access to dental care and I'll show you
some more information about that in a
moment
fluoride varnish when it is applied
routinely every three to six months
helps to prevent caries and it actually
helps remineralize mild decay that's
already present on the teeth it's both
safe and effective one of the key
questions that's come up around fluoride
varnish application is what if they've
had fluoride varnish applied somewhere
else recently like the dentist or at
local public health so the benefits of
routine application every three months
for high-risk children are well
documented and fluoride varnish
application is not dangerous or toxic so
even if it was done very recently
there's no harm in reapplying now of
course it doesn't make sense that the
child went to the dentist yesterday and
got fluoride varnish applied there's no
need to apply it again
in the clinic that day however given the
current low access to dental care in the
case of children who have already
received fluoride varnish recently will
probably not be very frequent however
there are screening exceptions that
clinics can use if they do not provide
fluoride varnish or if the family
refuses so what's stated in again this is
in the MHCP provider manual that you
can access online if fluoride varnish
was applied in another setting within
the last 30 days providers can code for
a screening exception but they just need
to document the date that fluoride
varnish was applied previously on the
MDH website you'll find more information
on fluoride varnish for C&TC providers
including resources for staff training
which is required there's an online
module that's fairly brief that
medical assistants and others who are
actually applying the fluoride varnish
for should watch and it also includes
information for parents there's a
fluoride varnish application send home
sheet for families that's available as
well Child and Teen Checkups as always
should continue to promote a dental home
by giving a verbal referral at every
Child and Teen Checkups prevent for
preventive services with a dentist they
also can do an oral risk health
assessment as recommended by the AAP and
that can help decide which patients
should also be getting fluoride
supplementation and who will need more
active assistance to get into a dental
visit soon
due to immediate dental concerns this
graph will help explain the importance
of prevention and primary care around
around dental issues and dental caries
so in Minnesota our most recent Medicaid
data from 2016 shows that for children
under a year who do already have tooth
and it's again it's recommended that
children get their first dental visit at
the eruption of their first tooth or no
later than 12 months so in Minnesota
we're currently at less than a half of a
percent of infant's getting in to see
the dentist which may not be very
surprising but even for one to two year
olds who have well established teeth and
are likely already
at risk for developing caries we're at
about 10% of young kids getting in even
once in a year to see a dentist for
preventive care and then for 3 to 5 were
still under 40% of young children with
Medicaid that are able to get into the
dentist for preventive care so this just
highlights the important role that
primary care clinics and clinicians play
around oral health so providing
anticipatory guidance around oral
hygiene, lifting the lip as part of the
physical exam and really looking at the
teeth, applying fluoride varnish at every
visit through 5 years of age,
providing a verbal referral to get them
into for dental preventive visits, and
then doing that oral health risk
assessment so those were the major
clinical changes and I want to just
briefly address some other more minor
additions to the C&TC periodicity
schedule one is that the health history
now and just includes mention of social
determinants of health and there's not
anything prescriptive that says that you
need to do a particular screening or
questionnaire it's just a recognition
that as all children but especially kids
who are eligible for Medicaid are at
risk due to whether it's financial
issues access to nutritious foods
exposure to neighborhood violence
what-have-you and so if you look at the
Child and Teen Checkups health history
fact sheet there's now a section there
about social determinants of health that
offers suggestions for how to include
that in the family history or in the
interim history that you do as a part of
each visit sorry I'm gonna go back to
fluoride varnish for a moment I just
want to clarify that fluoride varnish
application is actually recommended for
all children not just Medicaid eligible
children so if you look at the most
recent US Preventive Services Task Force
recommendations they do recommend that
all children receive fluoride varnish
routinely from the eruption of the first
tooth through 5 years of age so there's
no need to do a risk assessment to
determine which of your patients needs
fluoride varnish this could be a
practice that's established across your
practice
okay back to these additional caveats
previously we had a substance use risk
assessment line it's now just called
tobacco alcohol and drug use instead and
so there's an updated fact fact sheet
that has new resources that may be
helpful to you in your as you provide
risk assessment and respond to the
results of that risk assessment the
HIPAA compliant referral codes have are
required in order to build for a
complete Child and Teen Checkup and
there's a new fact sheet that now just
briefly explains how do you choose one
of those four codes and what other codes
used for so not only do they indicate
that a complete Child and Teen Checkups
visit has been done and and as such is
required to build for a full Child and
Teen Checkup these codes are also used
by local Child and Teen Checkups program
outreach staff in the counties and
tribes to follow up with families to see
if they need assistance to access
recommended health services there are
some new parent resources we've
mentioned a couple of those already but
there will be new brochures coming out
with some pamphlets and things to help
families prepare for the visits and help
prioritize the visits and those will be
more information will be coming out as
those additional resources are available
so one of the main questions has come up
that's not clinical is if we are not
able to implement these yet are we still
able to bill for a complete Child and
Teen Checkup so you can bill and you
should bill for whatever services you
have provided so for example each
component that you've done and you would
get reimbursement for a well visit
however providers may only billed for a
complete Child and Teen Checkups visit
and that special bundled rate when all
of the required screening components for
that age of that patient have been
provided according to the new screening
requirements including instruments or
tools and the process for that screening
requirement
so in the case of a visit where the
provider is not able to provide all of
the required Child and Teen Checkups
components at a well visit the provider
then would not enter one of the four
referral codes to indicate a complete
Child and Teen Checkups however if the
providers are able to complete all those
required components that's when they
would use that choose one of the four
referral codes and document that in
order to bill for a complete Child and
Teen Checkup again if you have more
questions about the policy or any
billing or coding questions please
either refer to the MHCP provider
manual online or email DHS for further
information however if your questions are
more clinical you want help choosing
screening equipment or ideas about
referral resources ideas about how other
clinics have implemented some of these
screening components please feel free to
either check the MDH Child and Teen
Checkups website for information about
each of the screening components or
email the child health consultants at
us at health.child.teencheckups at state.
MN.us. and thank you for taking the time
to do this and thank you for the care
that you provide to children in
Minnesota
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