CHILD AND TEEN CHECKUPS (C&TC)
Maternal Child Health Advisory Task Force - 3/13/2015
Anne Kollmeyer & Steve Masson (DHS), Katy Schalla Lesiak (MDH)
What is EPSDT?

Federal program – Centers for Medicare and Medicaid
Services (CMS)
Early
Periodic
Assessing and identifying problems early
Screening
Providing physical, mental, developmental,
dental, hearing, vision, and other screening test
to detect potential problems
Diagnosis
Performing diagnostic tests to follow up when a
risk is identified
Treatment
Control, correct or reduce health problems found
Checking children’s health at periodic, ageappropriate intervals
Child and Teen Checkups (C&TC)


Minnesota’s EPSDT program
Eligibility criteria:
 Age
newborn through 20 years
 Eligible for Medicaid/Medical Assistance (MA) or
MinnesotaCare
 Eligibility

criteria can change each legislative session
Administered by Minnesota Department of Human
Services (DHS)
C&TC federal requirements

State Medicaid agencies are required to:
 Inform
all Medicaid-eligible individuals under age 21
that EPSDT services are available and of the need for
age-appropriate immunizations;
 Provide or arrange for the provision of screening
services for all children;
 Arrange (directly or through referral) for corrective
treatment as determined by child health screenings;
and
 Report EPSDT performance information annually via
Form CMS-416
Parts of the C&TC program
5

Two Parts to the Program
1. Administrative
 State
agencies (DHS)
 DHS
administers contracts with 44 Community Health
Boards(87 counties) and 4 tribes for C&TC outreach
 2015
number of estimated eligibles: 521,716
 Budget
Year 2015: $13,825,475
6
Administrative Services added in 1979
States are required to meet five objectives related to
improving access to services:
1.
Provide information to eligible families & children
2.
Assist families & children in accessing services
3.
Track “yes”, “no”, and “undecided”
4.
Coordinate with other child-related programs
5.
Recruit & train providers about the program
C&TC outreach – Fond du Lac
is Your
Child·s Health?
C&TCHow
outreach
– Morrison
County
Regular Checkups Help to Spot Problems Early On
If you have Medical Assistance or M innesotaCare, your child is eligible
for Child & Teen Checkups, a comprehensive health screening.
A C&TC counts as a Sports Physical, and you may be eligible for
vouchers from your health plan valued up to $100 for completion
of the C&TC visit .
~"
,:t ••
'1'\
9 oo uglas~df'Jt p
00
~'§;
3
Central MN
\
~
~
P u blic Health & H ealth Plans ; ,
Wor king Togeth er to
'9o I m prove Children's Health ,qi lf'-
£
o
~
~-
'<',r.
-,<l-~71
_ _ _ __
~
~
@
l
<"t~
~
C&TC Collaborative
~
~
•
~
o<::-
~-..;
q;,q,
~
~DI~~
- O..o(Q
;.>s ~
(J./f'J
.-.\'>
))O'P
- -9Jaq5 oU!d uoS\
Contact Morrison County Public Health (or you r h ealth plan)
for more information 320-632-6664 or 1-866-401-1111
C&TC outreach – Hennepin County
Child and Teen Checkups
well-child exams for kids
If }'OU are on Medical Assistance or Minnesot.aCare,
call 612-348-513 1 for information and assistance
making an appointment, or contact your clinic directlr
H
Child and Teen Checkups
htnnep1n.us'chPr~11ps
Parts of the C&TC program, continued
2. Comprehensive Direct Health Services
 Health
Care Providers
 Supported
by Minnesota Department of Health (MDH)
 DHS administers DHS/MDH Interagency Agreement
 MDH C&TC staff responsible for provider training
 2015-2016 Agreement uses DHS data to assess and
prioritize training needs
MDH role

Review and updating of recommendations to DHS
based on national recommendations and other factors

Consultation with statewide experts and partners




Examples: new hearing, vision screening guidelines
Training, consultation and technical assistance for C&TC
and other screening providers on all screening
components
Resources: website, fact sheets, training modules, inperson training
Redevelopment of training plan
Goal: better reach C&TC providers
 Methods: in person, web resources, online learning

C&TC Periodicity Schedule
12
C&TC Screening Components










Anticipatory guidance (health education)
Measurements: height, weight, BMI, blood pressure
Health history
Developmental and mental health surveillance and screening
Physical exam
Lab tests: hemoglobin, lead
Risk assessments: tuberculosis, sexually transmitted infections
Vision
Hearing
Dental checkups / fluoride varnish
How are C&TC requirements & recommendations determined?


Evidence-based screening practice
National recommendations






American Academy of Pediatrics and others
US Preventive Services Task Force
Centers for Disease Control and Prevention
Center for Medicare and Medicaid Services (CMS) and
state requirements
Legislative decisions (funding)
Unique needs/risks of population:
Eligible for Medicaid or MinnesotaCare = higher risk
 Epidemiologic data

Minnesota EPSDT screening rates (Goal: 80%)
MN EPSDT Participation Ratio 2013 (CMS)
100
90
Participation Ratio
80
70
60
50
40
30
20
10
0
<1
1-2
3-5
6-9
Age in Years
10-14
15-18
19-20
Annual CMS-416 Participation Rate by County or Tribe: FFY 2013
DHS Child and Teen Checkups Program
C&TC Health Plans and County Based
Purchasing Representatives


DHS contracts with Health Plans/County Based
Purchasing
Each has C&TC Representative(s) to…
 Collaborate
with DHS, C&TC coordinators and providers
 Provide plan-specific training and technical assistance:
 billing
 coding
 reimbursement
BONUS:
Resources,
Training support,
Incentives for families
Policy changes and periodicity
schedule updates: Fluoride varnish

Fluoride varnish

New CPT code 99188 effective 1/1/15

Application of topical fluoride by a physician or other qualified
health care professional for patients who are at high risk of caries

D1206 will continue to be used for billing for fluoride
varnish applied by other clinic staff or other non-dental
staff

Staff need to have completed approved fluoride training
Policy changes and periodicity
schedule updates, continued

Periodicity Schedule
 Fluoride
varnish will be added to C&TC Periodicity
Schedule as a recommendation in 2015
 US
Preventive Task Force, May, 2014
 DHS policy and information is being updated
 DHS and MDH C&TC staff will be coordinating
communications and training materials
Policy changes and periodicity
schedule updates: Screening



Developmental and social emotional/mental health
screening
CPT code 96127 for a social emotional/mental
health screening with a standardized instrument
Strengthens the language around using
standardized instruments recommended by
Minnesota Interagency Developmental Task Force
Database and logo updates

WebCATCH database system moving forward
 Currently

using CATCH3 database
New Child and Teen Checkups logo
DHS C&TC Staff






Steve Masson, Manager Benefit Policy - Health
Services
Anne Kollmeyer, C&TC Policy and Project Manager
C&TC Operations Specialist – Vacant
Kimberly Yerke, Office Administrative Specialist, Sr.
CATCH3 Support
Provider Help Desk
DHS Resources

Minnesota Health Care Programs (MHCP) Provider
Manual, C&TC Section
www.dhs.state.mn.us/dhs16_150092
 C&TC
requirements
 Billing and coding information

Minnesota C&TC Coordinator website:
www.dhs.state.mn.us/id_000307
CMS Resources


www.Medicaid.gov
Early and Periodic Screening, Diagnostic, and
Treatment website
 http://www.medicaid.gov/Medicaid-CHIP-Program-
Information/By-Topics/Benefits/Early-and-PeriodicScreening-Diagnostic-and-Treatment.html
 (includes CMS-416 reports)
MDH Staff



Community and Family Health Division, Maternal
Child Health Section, Child & Adolescent Health Unit
Kathy Wick, Supervisor
Child Health Consultants:
Faith Kidder
Sheila Pelzel
Katy Schalla Lesiak


Sheila Blackman – Office & Admin Specialist Sr.
Student workers – Master’s level (MPH or other)
MDH Resources




Child and Teen Checkups website: fact sheets, training
resources www.health.state.mn.us/divs/fh/mch/ctc/
Developmental and Social-Emotional Screening of Young
Children (0-5) in Minnesota
www.health.state.mn.us/divs/fh/mch/devscrn/
Hearing Screening
www.health.state.mn.us/divs/cfh/topic/hearingscreening/
Vision Screening
www.health.state.mn.us/divs/cfh/topic/visionscreening/