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