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Correction: CHDP Notice – Additional Bright Futures Benefits Reimbursable Beginning July

August 9, 2016

The CHDP Bright Futures Schedule for Health Assessments by Age Groups chart that posted on the Medi-Cal website on June 29, 2016, contained errors. Some entries showing the number of months between health assessments were inaccurate. The intervals have been corrected in the health assessments schedule, which can be viewed via the link below.

The Child Health and Disability Prevention (CHDP) program provides fee-for-service, well child health assessments to Medi-Cal children and youth pursuant to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit of the Medi-Cal program.

Effective for dates of service on or after July 1, 2016, the American Academy of Pediatrics (AAP) Bright Futures periodicity schedule for fee-for-service, well-child health assessments is implemented for CHDP. See both the CHDP Bright Futures Schedule for Health Assessments by Age Groups and CHDP/EPSDT Periodicity Schedule for Dental Referral by Age for guidelines

The information on the health assessment periodicity schedule being released supersedes the CHDP Periodicity Schedule for Health Assessment Requirements by Age Groups on the Medi-Cal website and in the Appendix of the CHDP provider manual. The information on the dental periodicity schedule being released supersedes any dental periodicity schedule dated prior to 2016.

Under the Bright Futures health assessment periodicity schedule, 14 additional health assessments will be added to the 15 health assessments presently reimbursable for children and youth from birth to age 21.

Claims for the additional assessments shown below should be billed as Medically Necessary Interperiodic Health Assessments (MNIHAs) on the CHDP Confidential Screening/Billing Report (PM 160) claim form.

  INFANCY EARLY CHILDHOOD MIDDLE CHILDHOOD
AGE By 1 mo 30 mo 5 y 7 y 8 y 10 y
Bill as a MNIHA Yes Yes Yes Yes Yes Yes

  ADOLESCENCE
AGE 11 y 12 y 14 y 15 y 16 y 18 y 19 y 20 y
Bill as a MNIHA Yes Yes Yes Yes Yes Yes Yes Yes

To bill one of the 14 health assessments, providers should enter the following in the Comments/Problems area of the claim:

MNIHA:  There is a need to complete health assessment requirements

Provider types who use the Confidential Screening/Billing Report (PM 160 Information Only) for reporting purposes also should follow the preceding instructions for reporting the 14 additional assessments.

This policy will be released in the provider manual in a future CHDP Update bulletin.