Closing gaps in lead testing and developmental screening for Keystone HMO CHIP members

March 18, 2021

​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 regardless of risk level.

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.

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 ages 9 months, 18 months, and 30 months, or when surveillance yields concern. The screening should be documented in the patient's chart and included in a claim.

What your practice should do

To help ensure your patients receive the required testing, your practice can do the following:

  • EBLLs: Perform a risk assessment on children at ages 6 months, 9 months, 18 months, and then annually from ages 3 – 6, with testing as appropriate.

  • Developmental screening: Perform developmental surveillance at each well-child visit and for children at ages 9 months, 18 months, and 30 months. Please be sure to document in the member's chart, 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:

  • Well-child visits: Children who turn 15 months 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. Schedule well-child visits to coincide with EBLL and developmental screening visits whenever possible.

  • 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.

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. Visit the DHS website to access the application, requirements, and step-by-step instructions related to the enrollment process.

Resources

Visit the Independence website for information on lead testing and developmental screening recommendations, prevention, and safety.

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