Medica’s guidelines for Preventive Services for Children and Adolescents are adopted from the Institute for Clinical Systems Improvement (ICSI). These guidelines were developed with input from specialists in family practice and pediatrics, and endorsed by Medica’s Medical Policy Committee.
View schedule guidelines for Preventive Services for Children & Adolescents.
In addition to the ICSI Preventive Services guidelines, Medica has created a visit schedule guideline for high-risk children, including those living in low socioeconomic conditions, such as children enrolled in Medica Choice Care (Medical Assistance, General Assistance Medical Care) and Medica Minnesota Care. Other factors related to high risk include a history of chemical dependency or violence in the family, and certain medical conditions or circumstances in which the child may benefit from closer monitoring.
View schedule guidelines for Preventive Services for High-risk Children and Adolescents.
Please note: Clinical guidelines are intended to encourage quality patient care, but cannot guarantee specific patient outcome, and should be used only as a reference guide. The guidelines are not intended to replace a clinician’s judgment regarding the care needed by individual members or to establish protocols for the care of all members. Coverage of specific services may vary based on the terms of specific member contracts (including state and federal government program contracts), administrative policies and state/federal mandates.
Medicaid requires that every person, from birth to age 21, who is enrolled in Minnesota Health Care Programs (e.g., Medica Choice Care and Medica MinnesotaCare) receive the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.
Minnesota’s EPSDT Program is named Child & Teen Checkups (C&TC). This comprehensive child health program is provided to children and teens from newborn through the age of 20 who are enrolled in Medical Assistance or MinnesotaCare. View guidelines for Child & Teen Checkups.
The purpose of the C&TC program is to:
- Identify potential health problems or handicapping conditions.
- Provide diagnosis and treatment of those health problems or conditions.
- Encourage the development of good health habits.
The Centers for Medicare & Medicaid Services (CMS) requires states to report participation rates annually. Since 1995, the federal agency has mandated that states must have an 80 percent participation in C&TC screening services. This compliance rate is calculated by comparing the number of children who received their C&TC screenings to the total number of children who were eligible to receive a C&TC screening at least once during the reporting year.
Failure to demonstrate compliance may result in a loss of federal funding for these recipients.
To assist the state in proper reporting of such information, every health plan is required to electronically submit C&TC participation rate information to the Minnesota Department of Human Services (DHS) for every child enrolled in Minnesota Health Care Programs, such as Medica Choice Care and Medica MinnesotaCare.
A provider who follows the ICSI Preventive Services and Medica’s high-risk visit schedule guidelines for children at high risk will meet or exceed the C&TC required screening timelines with their specific components.
Medica guidelines emphasize the need for continuity of care. Primary care providers offer this continuity by coordinating each child’s health care, thus ensuring that children receive all the services they need and do not receive duplicate services.
Well child checkups (Child & Teen Checkups) should be coordinated with sick child, prenatal, newborn/well baby, immunization, family planning and Supplemental Food Program for Women (WIC) visits. Checkups also may be coordinated with Head Start, school, camp and athletic physicals.
If any component of the checkup for a high-risk child (Medica Choice Care and Medica MinnesotaCare members) cannot be performed, the provider must document the rationale for the inability to provide that specific component. By providing this documentation, the provider will have satisfied the requirements for a complete well child checkup (Child and Teen Checkup).
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