CCHAP Newsletter Four
Contents:
- Developmental Screening For Low Income & Minority Children -
- Integrating Developmental Screening in Primary Care Practice -
- New Asthma Case Management Program -
- Oral Health and Medicaid -
- CCHAP Orientation Manual Online -
- CCHAP Expansion Metro-wide -
- Announcements -
Next Practice Liaison Teleconference
Thursday, February 25th
12:30 PM
Topics:
1. How to effectively help parents who are angry
2. How to work with families in which the parents disagree about treatment (but the father never comes to visits)
3. How to work with families that have parenting attitudes/behaviors that could harm the child
RSVP
Joanie Muzzulin
Muzzulin.Joan@tchden.org
303-861-6309
Developmental Screening
for Low Income and Minority Children
The AAP recommends developmental screening at well child visits for all children
Cololorado State Department of Public Health and Environment has received a grant to assist pediatric practices in implementing developmental and behavioral screening in the office.
Colorado State Department of Health Care Policy and Financing (EPSDT division) encourages practices to do developmental screening for Medicaid children by reimbursing well for it.
Why do developmental screening with a standardized screening tool?
- Improved identification of both developmental and behavioral problems in pediatric offices compared to history and exam alone.
- Earlier recognition of problems needing early intervention.
- Parents are very grateful for the screening questions and parent satisfaction rates with the pediatric practice skyrockets.
- Parent questionnaires help the parent organize their concerns, which facilitates anticipatory guidance. It unearths questions and concerns more quickly at visits.
What have pediatricians done in other states?
- Pediatricians in many other states have agreed to do developmental testing on all young children at health maintenance visits.
- The most commonly used, best standardized and cost-efficient screening tools are the Ages and Stages Questionnaire (ASQ) and the Parents Evaluation of Developmental (PEDS). The Denver II (popular in Colorado) is less often chosen in other states.
Reasons providers have resisted developmental screening and how parent questionnaires can address these concerns
Most reasons for not wanting to do developmental screening relate to past experience with screening tools that require more staff or provider time. However, parent questionnaires effectively address most of these concerns.
Which screening tool should we use?
An evaluation of all of the options was conducted by the Colorado State Health Department and the Section of Child Development (UCHSC), with representation from private pediatric practices. The preferred screening tools were the ASQ and the PEDS.
The Ages and Stages Questionnaire (ASQ)
- 6 months to 5 years
- Staff – paraprofessional (MA) can score. Provider interprets score.
- Screens developmental and emotional (behavioral)
- Takes 1 minute for paraprofessional to score.
- Reading level – 4-6 grade level
- Sensitivity – 78% Specificity – 95%
- Cost $199 (discount available)
- Some practices put the ASQ on their practice website and when parents call to make health maintenance visit appointment, they are asked to download ASQ and fill it out prior to visit.
- To learn more: ASQ web site - http://www.agesandstages.com/
- Discount available for your practice: 30% Discount & Flat $10 Shipping. Must reference savings code COASQ30. Offer valid from May 1, 2007 to December 31, 2007
The Parent’s Evaluation of Developmental Status (PEDS)
- birth to 8 years
- Staff – paraprofessional (MA) can score. Provider interprets score.
- Screens developmental and emotional (behavioral)
- Takes 1 minute for paraprofessional to score.
- Reading level – 4-6 grade level
- Sensitivity – 75% Specificity – 80%
- Cost – can get started for around $150
- Some practices put the PEDS on their practice website and when parents call to make health maintenance visit appointment, they are asked to download PEDS and fill it out prior to visit.
- To learn more: http://www.pedstest.com/index.php
Can we start with 2-3 visits to get acquainted?
Some practices are reluctant to incorporate this into every visit. Most practices wind up using the ASQ or PEDS at all health maintenance visits. If you want to start with 3 visits, the AAP 2006 Policy statement suggests: 6 (or 9) months, 18 months and 24 (or 30) months.
Billing and Coding
Diagnosis codes
Periodic screening – V20.2
Inter-periodic screening – V70.3
CPT code – age-appropriate preventative services visit.
CPT code for developmental screening – 96110
Medicaid pays $34.33
Commercial insurance average reimbursement $18
Integrating developmental screening into the practice – Key Points
- A provider or staff person to champion it.
- Develop a consistent plan for work flow
o Who will keep the copies of the questionnaire available (copied)?
o At the visit, who will give the parent the questionnaire?
o Who will score the questionnaire?
o How/when during the visit will the questionnaire be reviewed?
o How will the provider and staff handle referrals?
o Who will be responsible for keeping a list of referral resources?
o Where will you keep the materials?
Referrals for Further Evaluation
Many cultures have an attitude toward developmental delays that may differ from their healthcare provider’s. Some cultures see the delays as “God’s will” or they may have a greater tolerance for “differences”. These cultural attitudes can be discovered and responded to with the questions and approaches described in e-Newsletter #2. Many families will have difficulty in navigating the systems for evaluation. They may need extra help from practice staff or a care coordinator or social worker.
If you need advice on where to refer a child, contact: Eileen Bennett at 720.333.1351.
Want to read more about how other states accomplished this?
PEDIATRICS. Volume 118. Number 1. July, 2006 http://www.pediatrics.org/
For free training for office staff, see the announcement below
Save the Date!
Integrating Developmental Screening in Primary Care Practice
Training Workshop
Wednesday, May 9, 2007, 12 – 4 PM
- Learn about Colorado’s Assuring Better Child Health and Development (ABCD), a statewide effort to help practices incorporate standardized developmental screening tools into their practice.
- How to integrate standardized screening into a primary care practice.
- Information about the referral process for early intervention services.
Locations:
Denver (Live Site)
The Children’s Hospital, 1056 E. 19th Avenue, 6th Floor Lecture Hall, Denver (Parking available in the garage at Downing & 20th for $2)
Webconferencing – The live presentation will be available online through any computer with an internet connection with speakers. Limited spots are available for webconferencing, so we encourage groups to gather to view the presentation by projection through an LCD from a laptop with speakers. If you are a group gathering, only 1 person from the group should register and that person will be emailed directions and the URL for the seminar.
Check for registration information at http://www.jfkpartners.org/workshops.asp
Asthma Case Management Program
For those Medicaid or CHP+ children whose asthma is in poor control, or whose family needs a lot more education or support, or are not following up appropriately with health care, the Pediatric Pulmonary Division at The Children’s Hospital offers an asthma case management program. To refer a child/family for an appointment, call the asthma nurse case manager, Julie Gannon at 303-860-4701. She will contact the family and make sure they receive a thorough evaluation. The asthma program will develop an asthma care plan, educate the family completely, and coordinate care with your practice providers. The nurse case manager is available to the family by phone to assist with care decisions.
EPSDT Update:
Oral Health Services and Medicaid
By Gina Robinson
“No one should suffer from oral diseases or conditions that can be effectively treated or prevented.” Richard H. Carmona, MD, MPH, FAC, Surgeon General, U.S. Public Health Service
For children, cavities are a common problem that begins at an early age. Tooth decay affects more than one-fourth of U.S. children aged 2–5 and half of those aged 12–15. Low-income children are hardest hit: about half of those aged 6–19 years have untreated decay. Untreated cavities may cause pain, dysfunction, absence from school, low weight, and poor appearance—problems that can greatly reduce a child’s capacity to succeed in life. Tooth decay is concentrated in low-income children who are most likely eligible for Medicaid.
Under the requirements of Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Medicaid must provide comprehensive coverage of all medically necessary dental services for children and adolescents under age 21. Dental services must be provided at intervals determined to meet reasonable standards of dental practice. Although an oral screening may be a part of a physical examination, it does not substitute for examination by a dentist.
A direct dental referral is required for every child after age one in accordance with the Colorado Medicaid periodicity schedule set forth in Medicaid rules 8.282(E) and 8.282(F). The appointment may be initiated by a verbal referral or a parental referral on behalf of the child, and does not require the completion of a referral form.
Outreach and Case Management are an integral component of EPSDT. The Department Health Care Policy and Financing provides Outreach and Case Management Services through local departments of public health and other governmental agencies throughout the state. EPSDT Outreach and Case Management programs are required to maintain an accurate list of available Medicaid providers and a list of where to access non-Medicaid services at a reduced rate or for free. These EPSDT Outreach and Case Managers can help educate parents about the importance of medical and oral health, the need for early care to prevent common medical and dental problems, and to provide follow up assistance to the primary care and dental providers. The case managers can also work with parents who frequently miss appointments and teach parents how to use the Medicaid delivery system.
To obtain a list of EPSDT Outreach and Case Management offices, please visit the Health Care Policy and Financing EPSDT Tool Kit at: http://www.chcpf.state.co.us/HCPF/EPSDT/EPSDT_Final_page2.asp
or call Gina Robinson, Program Administrator at (303) 866-6167 for more information.
CCHAP ORIENTATION MANUAL NOW ON WWW.CCHAP.ORG
A new, updated version of the Orientation Manual is available on www.cchap.org for all practices participating in the CCHAP project. You will need a log-in name and a password to gain access to the on-line version of the CCHAP Manual. The log-in box and a link to the Orientation Manual is on the left side of the home page. Each CCHAP Practice Administrator will be given the log-in and password for their practice. Please contact Joanie Muzzulin (muzzulin.joan@tchden.org) if you have not received it.
This Manual will always be a work in progress, and we will appreciate your comments and suggestions to improve it. It will be easier to get corrections and updates out to everyone now that it is on-line. When we make substantial additions or changes, we’ll let you know in this newsletter. Click here to login
Note to CCHAP Pilot Practice Administrators: When we started the pilot phase, we gave several copies of the manual to each practice in blue notebooks. We recommend you print out a new copy of the manual and replace all of the pages in one of those notebooks (or as many as you would like to keep updated). Then please destroy all old copies of the pages in those notebooks, because the information is outdated. We hope you will find this new version more helpful.
Metro-wide CCHAP Expansion
As you know, CCHAP has been piloted the past 18 months in 7 private pediatric practices in metro Denver. The practice administrators, providers and staff have helped develop the program and make it successful. We will always be grateful for their contributions. We began our expansion in January, 2007. In February, 2007, there are 17 practices participating in CCHAP, in 20 locations:
6 in Aurora,
4 in South Metro
4 in West Metro
2 in Parker
1 in Metro Denver
We are adding 1-2 practices a week and plan for 70 private pediatric practices in the metro area to participate by the end of 2007.
We are also beginning to work with practices outside of the metro area and plan for 130 pediatric practices to participate by the end of 2008.
To those of you who have contributed ideas, completed surveys, and participated with CCHAP, THANK YOU!!!!
Announcements
CCHAP offers a convenient, time-efficient, cost-efficient medical Spanish interpretation training program for pediatric office staff and providers. It is provided as a telephone conference, during practice office hours at lunch time
Training in medical Spanish interpretation includes:
Medical (pediatric) terminology
The subtle differences in the two languages in word selection and grammar
Culturally appropriate communication skills
Professionalism and etiquette of interpretation
Confidentiality and HIPPA issues
When: Wednesdays from 12:15 to 1PM
Starting: Next session will start in April
How long: 45 minute sessions for 6 weeks
Price: $15 per session. Please send check for $90, payable to International Language Services, 12572 West Brandt Place, Littleton CO 80127.
Registration – Register simply by emailing the information below to ilssoto@aol.com
1. Name of student:
2. Job title:
3. Pediatric practice name:
4. Work phone number:
5. Home phone number:
6. Is your first language English or Spanish?
7. If Spanish is your second language, how long have you been speaking it?
8. What time is your usual lunch hour?
9. What is your goal in enrolling in this class?
Next Practice Liaison Teleconference
12:30 PM
Topics:
- How to effectively help parents who are angry
- How to work with families in which the parents disagree about treatment (but the father never comes to visits)
- How to work with families that have parenting attitudes/behaviors that could harm the child
RSVP
Joanie Muzzulin
Muzzulin.Joan@tchden.org
303-861-6309
Contents:
- Developmental Screening For Low Income & Minority Children -
- Integrating Developmental Screening in Primary Care Practice -
- New Asthma Case Management Program -
- Oral Health and Medicaid -
- CCHAP Orientation Manual Online -
- CCHAP Expansion Metro-wide -
- Announcements -
- newsletter archive - home -
