VISION SCREENING PCPs must perform a subjective vision screening (i.e., by history) at each well child visit. For asymptomatic children 3 years of age and older, an objective screening must occur as indicated on the AAP periodicity schedule. For children of any age, referral to an optometrist or ophthalmologist must be made if there are symptoms or other medical justification (e.g., parent/guardian has suspicions about poor vision in the child). The AAP requires a vision risk assessment at each well child visit. MDHHS requires vision testing at specific well child visits for children 3 years of age and older.

PRESCHOOL Due to behavior and comprehension ability of children younger than 3 years of age, the standard screening is subjective. An objective screening should begin at 3 years of age. An objective vision screening is accomplished using a standardized screening tool and may be performed on Medicaid eligible preschool-age children each year beginning at 3 years of age through 6 years of age by qualified Local Health Department (LHD) staff. If the child is uncooperative, the screening should be re-administered within six months. LHDs may provide objective vision screening services and accept referrals for screening from the PCP and from Head Start agencies.

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In an effort to promote communication with the child’s medical home, the objective vision screening results must be reported to the child’s PCP. In the event the LHD is unable to report the objective vision screening results to the child’s PCP, the LHD must clearly document why this could not be accomplished. If the LHD receives authorization, the results may be shared with the Head Start agency if that agency was the referral source. SCHOOL AGE A subjective vision screening must be performed at each well child visit; an objective screening shall be performed as indicated on the AAP periodicity schedule. PERIODICITY SCHEDULE FOR VISION SCREENING A vision screening is to be performed at 3, 4, 5, 6, 8, 10, 12, 15, and 18 years of age. Spartiti Per Pianoforte Pdf there. A risk assessment is to be performed, with appropriate action to follow if positive, for newborns and during the ages of: * 3 to 5 days * 1 month * 2 months * 4 months * 6 months * 9 months * 12 months * 15 months * 18 months * 24 months * 30 months * 7 years * 9 years * 11 years * 13 years * 14 years * 16 years * 17 years * 19 years * 20 years DEVELOPMENTAL/BEHAVIORAL ASSESSMENT A developmental/behavioral assessment is required at each scheduled EPSDT well child visit from birth through adolescence as recommended by the AAP periodicity schedule.

The PCP should screen all children for developmental and behavioral concerns, including engaging in risky behavior, using a validated and standardized screening tool as indicated by the AAP periodicity schedule. A maximum of three objective standardized screenings may be performed in one day for the same beneficiary by a single provider. (Refer to the Billing & Reimbursement for Professionals Chapter for billing instructions.) If the screening is positive or suspected problems are observed, further evaluation must be completed by the PCP, or the child should be referred for a prompt follow-up assessment to identify any further health needs. The provider may administer additional screenings, surveillance, or assessments as described in the following subsections. DEVELOPMENTAL SCREENING A developmental screening using an objective validated and standardized screening tool must be performed following the AAP periodicity schedule at 9, 18 and 30 (or 24) months of age, and during any other preventive health care well child visits when there are parent/guardian and/or provider concerns.

Developmental screening may be accomplished by using a validated and standardized developmental screening tool such as the Ages and Stages Questionnaire (ASQ) or Parents’ Evaluation of Developmental Status (PEDS). If the screening is positive, PCPs should further evaluate the child, provide counseling, and refer the child as appropriate. CHILDREN’S MULTI-DISCIPLINARY SPECIALTY (CMDS) CLINIC REQUIREMENTS CMDS clinics are required to operate under the authority of hospitals or medical universities. Hospitals and medical universities requesting CMDS clinic designation must adhere to the requirements as stated in this policy and acquire approval and oversight from the CSHCS program. Hospitals and medical universities that administer CMDS clinics require a separate National Provider Identifier (NPI) number with which to enroll and submit claims for the CMDS clinic fee. CSHCS-approved organizations with responsibility for CMDS clinics must enroll through the online MDHHS CHAMPS Provider Enrollment (PE) subsystem to be reimbursed for clinic fees for services rendered to eligible beneficiaries.

Each CMDS clinic must operate under the unique CMDS National Provider Identifier (NPI) held by the organization responsible for those CMDS clinics and must identify the providers who render the services in the CMDS clinic as affiliated providers. All affiliated providers whose services are directly reimbursable per MDHHS policy must be separately enrolled in CHAMPS and must also receive a beneficiary-specific authorization from CSHCS prior to the clinic billing for the clinic fees.

CLINICAL RECORDS The following table contains general guidelines for clinical documentation that must be maintained by all providers except nursing facilities. Clinical records other than those listed may also be needed to clearly document all information pertinent to services that are rendered to beneficiaries. All providers must refer to their specific coverage policy in this manual for additional documentation requirements. The clinical record must be sufficiently detailed to allow reconstruction of what transpired for each service billed. All documentation for services provided must be signed and dated by the rendering health care professional.

For services that are time-specific according to the procedure code billed, providers must indicate in the medical record the actual begin time and end time of the particular service. For example, some Physical Medicine procedure codes specify per 15 minutes. If the procedure started at 3:00 p.m. And ended at 3:15 p.m., the begin time and end time must be recorded in the medical record.

The medical record must indicate the specific findings or results of diagnostic or therapeutic procedures. If an abbreviation, symbol, or other mark is used, it must be standard, widely accepted health care terminology.

Symbols, marks, etc. Unique to that provider must not be used. Examples: ** When a test is performed, at a minimum, the test value for that beneficiary for that test must be noted. Additionally, the normal range of values for the testing methodology should be annotated in the record. ** When an x-ray is taken, the results or findings must be indicated. For example, a chest x-ray may indicate 'no pulmonary edema present' or 'no consolidation.' ** When a physical examination is performed, pertinent results or readings must appear.

** If blood pressure is taken, the actual reading must appear. ** If heart, lungs, eyes, etc.

Are checked, the results or findings must be detailed. ** Medical/surgical procedures performed must be sufficiently documented to allow another professional to reconstruct what transpired (e.g., 'I-D' is not sufficient documentation). Ce Freza Mi Se Potriveste Program Management here. ** When a complete physical exam is rendered, the level of service must be fully documented. ** If private duty nursing is provided, the care provided during each hour must be fully detailed.

Hospitals must retain any clinical information required to comply with 42 CFR 482.24. A nursing facility must retain any clinical information required to comply with 42 CFR 483.75 and the plan of care must comply with 42 CFR 483.20(d). These regulations are available from MDHHS or Centers for Medicare & Medicaid Services (CMS). (Hospitals and nursing facilities should refer to the Reimbursement Appendix of their chapters in this manual for additional record keeping requirements.) FISCAL RECORDS The following fiscal records must be maintained: ** Copies of Remittance Advices (RA); ** PA requests and approvals for services and supplies (including managed care authorizations); ** Verification of medical necessity and the provider's usual and customary charge for the noncovered service; ** Record of third-party payments; and ** Copies of purchase invoices for items offered or supplied to the beneficiary.

RECORD RETENTION Providers must maintain, in English and in a legible manner, written or electronic records necessary to fully disclose and document the extent of services provided to beneficiaries. Necessary records include fiscal and clinical records as discussed below.

Appointment books and any logs are also considered a necessary record if the provider renders a service that is time-specific according to the procedure code billed. Examples of services that are time-specific are psychological testing (per hour), medical psychotherapy (20-30 minutes), and vision orthoptic treatment (30 minutes). The records are to be retained for a period of not less than seven years from the DOS, regardless of change in ownership or termination of participation in Medicaid for any reason. This requirement is also extended to any subcontracted provider with which the provider has a business relationship.

ORDERS, PRESCRIPTIONS AND REFERRALS Providers arranging or rendering services upon the order, prescription or referral of another provider (e.g., physician) must maintain that order, prescription and/or referral for a period of seven years. BENEFICIARY IDENTIFICATION INFORMATION Providers must retain the following beneficiary identification information in their records: ** Name ** Medicaid ID number ** Medical record number ** Address, including zip code ** Birth date ** Telephone number, if available ** Any private health insurance information for the beneficiary, if available AVAILABILITY OF RECORDS Providers are required to permit MDHHS personnel, or authorized agents, access to all information concerning any services that may be covered by Medicaid. This access does not require an authorization from the beneficiary because the purpose for the disclosure is permitted under the HIPAA Privacy rule. Health plans contracting with the MDHHS must be permitted access to all information relating to services reimbursed by the health plan. Providers must, upon request from authorized agents of the state or federal government, make available for examination and photocopying all medical records, quality assurance documents, financial records, administrative records, and other documents and records that must be maintained. (Failure to make requested records available for examination and duplication and/or extraction through the method determined by authorized agents of the state or federal government may result in the provider's suspension and/or termination from Medicaid.) Records may only be released to other individuals if they have a release signed by the beneficiary authorizing access to his records or if the disclosure is for a permitted purpose under all applicable confidentiality laws. CONFIDENTIALITY MDHHS complies with HIPAA Privacy requirements and recognizes the concern for the confidential relationship between the provider and the beneficiary and protects this relationship using the minimum amount of information necessary for purposes directly related to the administration of Medicaid.

All records are of a confidential nature and should not be released, other than to a beneficiary or his representative, unless the provider has a signed release from the beneficiary or the disclosure is for a permitted purpose under all applicable confidentiality laws (refer to the Availability of Records subsection of this chapter for additional information). Providers are bound to all HIPAA privacy and security requirements as federally mandated.

If the provider receives a court order, a subpoena, beneficiary request, or other authorized request for medical bills, payment, or claims adjudication information, the information should be released. At the same time, copies of the court order, subpoena, beneficiary request, other authorized request, and any additional information should be faxed to the MDHHS TPL Section. (Refer to the Directory Appendix for contact information.) If there is a reason to suspect a duplicate payment has been or will be made, but the payment is not assigned, the provider should contact the TPL Section. TPL will make the necessary arrangements to collect the duplicate payment from the third-party source. If the provider questions the appropriateness of releasing beneficiary records, he is encouraged to seek legal counsel before doing so.

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