The Pennsylvania Department of Human Services (Commonwealth) 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 before 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.
- 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 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 services to CHIP members be enrolled with DHS as a CHIP provider.
- Upon enrollment, DHS will issue providers a PROMISe identification number.
- The deadline for CHIP providers to enroll with DHS was December 31, 2017. However, you may still enroll.
- Remember, registering as a CHIP-only provider does not mean providers must accept Medical Assistance beneficiaries.
- In the near future, a PROMISe ID will be required to receive payment from Independence for services rendered to CHIP members. This date will be communicated once determined by the Office of CHIP.
- As of the determined date, claims submitted to Keystone Health Plan East by a non-enrolled provider (i.e., one without a PROMISe ID) will not receive payment.
- Visit the DHS website to access the application, requirements, and step-by-step instructions related to the enrollment process.
The following resources provide additional information regarding lead testing recommendations:
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.
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