Originally published April 27, 2020 and updated on April 30, 2020 and May 6, 2020
As the COVID-19 pandemic situation continues to evolve, the Department of Health Care Services (DHCS) continues to closely monitor and assess appropriate next steps as well as release guidance to ensure the safety of Medi-Cal beneficiaries, health plan enrollees, medical providers, and California communities in general.
Well-child visits or regular checkups are an important way to monitor children’s growth and development. With the State’s stay at home guidance, and federal guidance on non-essential medical procedures, DHCS recognizes that beneficiaries/parent caregivers may be cautious about making medical appointments for well-child visits. Under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, Medi-Cal covers recommended vaccines, preventive care, and screening for infants and children as recommended by the American Academy of Pediatrics (AAP)/Bright Futures, and in accordance with the AAP Periodicity Schedule.
In light of the COVID-19 pandemic, the AAP has developed guidance on the provision of pediatric ambulatory services via telehealth during the pandemic. This guidance suggests that well-child care should occur in person whenever possible. Where community circumstances require pediatricians to limit in-person visits, this guidance encourages clinicians to prioritize in-person newborn care, and well visits and immunizations of infants and young children (through 24 months of age) whenever possible. Further, the AAP guidance indicates: “Well visits for children may be conducted through telehealth, recognizing that some elements of the well exam should be completed in clinic once community circumstances allow. These elements include, at a minimum: the comprehensive physical exam; office testing, including laboratory testing; hearing, vision, and oral health screening; fluoride varnish; and immunizations.
In accordance with the AAP guidance, and to ensure that services on the Bright Futures Schedule continue, DHCS encourages providers to follow the AAP guidance on pediatric ambulatory services described above, and also discuss with beneficiaries/parent caregivers the benefit of attending a well-child visit in person to receive necessary immunizations and screenings, as well as the provision of services via telehealth. DHCS also encourages providers to consider the risk of COVID-19 exposure during in-person visits, and ensure that they utilize options such as those included in the AAP website, which provides guidance on how to make modifications to the clinic structure and/or physical space.
Further, Medi-Cal’s telehealth policies allow providers the flexibility to provide medical care by telehealth/virtual telephonic telecommunication and bill Medi-Cal when the visit is done via this modality. Providers should inform beneficiaries/parent caregivers of their option to have some elements of a comprehensive well-child visit completed through telehealth and explain that certain parts of the exam can occur through telehealth and some parts of the physical exam and/or immunizations must be completed in person. To the extent there are components of the comprehensive well-child visit provided in-person due to those components not being appropriate to be provided via telehealth (e.g., those requiring direct visualization and/or instrumentation of bodily structures, or that otherwise require the in-person presence of the patient for any reason) and those components are a continuation of companion services provided via virtual/telephonic communication, the provider should only be billing for one encounter/visit.
For information on Medi-Cal’s telehealth billing and policy instructions, refer to DHCS’ existing policies, outlined in the Medi-Cal Provider Manual section, Medicine: Telehealth and the recently released fee-for-service and Managed Care telehealth guidance, posted to DHCS’ COVID-19 website.
For additional COVID-19 information and resources, we encourage you to review the following resources: