Early and Periodic Screening, Diagnostic and Treatment Services (Excerpts)

    EARLY AND PERIODIC SCREENING, 

07-90 DIAGNOSTIC AND TREATMENT SERVICES . 5123.2(Cont.) 
  

; [= Sereen all Medicaid eligible children ages 1-5 for lead poisoning. Lead poisoning is 

defined as an elevated venous blood lead level (i.e., greater than or equal to 25 

micrograms per deciliter (ug/dl) with an elevated erythrocyte protoporphyrin (EP) level 

(greater than or equal to 35 ug/dl of whole blood). In general, use the EP test as the 

primary screening test. Perform venous blood lead measurements on children with 

elevated EP levels. 

Children with lead poisoning require diagnosis and treatment which includes periodic re- 

evaluation and environmental evaluation to identify the sources of lead. 

9. Anemia Test.—The most easily administered test for anemia is a 

microhematocrit determination from venous blood or a fingerstick. 
  

3. Sickle Cell Test.—Diagnosis for sickle cell trait may be done with sickle cell 

preparation or a hemoglobin solubility test. If a child has been properly tested once for 

sickle cell disease, the test need not be repeated. 

  

4. Tuberculin Test.—Give a tuberculin test to every child who has not received 

one within a year. 
  

5. Others.—In addition to the tests above, there are several other tests to 

consider. Their appropriateness are determined by an individual's age, sex, health 

history, clinical symptoms and exposure to disease. These include a urine screening, 

pinworm slide, urine culture (for girls), serological test, drug dependency screening, stool 

specimen for parasites, ova, blood, and HIV screening. : 

E. Health Education.—Health education is a required component of screening 

services and includes anticipatory guidance. At the outset, the physical and dental 

assessment, or screening, gives you the initial context for providing health education. 

Health education and counselling to both parents (or guardians) and children is required 

and is designed to assist in understanding what to expect in terms of the child's 

development and to provide information about the benefits of healthy lifestyles and 

4 practices as well as accident and disease prevention. : eg 

  

F. Vision and Hearing Sereens.—Vision and hearing services are subject to their own 

periodicity schedules (as described in §5140). However, where the periodicity schedules 

coincide with the schedule for screening services (defined in §5122 A), you may include 

vision and hearing screens as a part of the required minimum screening services. 

  

1. Appropriate Vision Screen.—Administer an age-appropriate vision 

assessment. Consultation by opthalmologists and optometrists can help determine the 

type of procedures to use and the criteria for determining when a child should be referred 

for diagnostic examination. 

  

2. Appropriate Hearing Screen.—Administer an age-appropriate hearing 

assessment. Obtain consultation and suitable procedures for screening and methods of 

administering them from audiologists, or from State health or education departments. 

  

Rev. & 5-15 

  
  

 



  

  

EARLY AND PERIODIC SCREENING 

5140 DIAGNOSTIC AND TREATMENT SERVICES 07-90 
  

5140. PERIODICITY SCHEDULE 

A. Requirements for Periodic Screening, Vision, Hearing and Dental Services.— 

Distinct periodicity schedules must be established for screening services, vision services, 

hearing services and dental services (i.e., each of these services must have its own 

periodicity schedule). 

  

| Screening, vision and hearing services must be provided at intervals which meet 

reasonable standards of medical practice. You must consult with recognized medical 

organizations involved in child health care in developing reasonable standards. 

Dental services must be provided at intervals you determine meet reasonable standards of 

dental practice. You must consult with recognized dental organizations involved in child 

health care to establish those intervals. A direct dental referral is required for every 

child in accordance with your periodicity schedule and at other intervals as medically 

necessary. Prior to enactment of OBRA 89, HCFA in consultation with the American 

‘Dental Association, the American Academy of Pediatrics and the American Academy of 

Family Practice, among other organizations, required direct referral to a dentist 

beginning at age 3 or an earlier age if determined medically necessary. The law as 

amended by OBRA 89 requires that dental services (including initial direct referral to a 

dentist) conform to your periodicity schedule which must be established after consultation 

with recognized dental organizations involved in child health care. The periodicity 

schedule for other EPSDT services may not govern the schedule for dental services. It is 

expected that among older children dental services occur with greater frequency than 

with physical examinations. 

B.. Requirements for Interperiodic Screenings.—You must provide for interperiodic 

screening, vision, hearing and dental services which are medically necessary to determine 

the existence of suspected physical or mental illnesses or conditions. 

  

The determination of whether an interperiodic screen is medically necessary may be made 

by a health, developmental or educational professional who comes into contact with the 

child outside of the formal health care system (e.g., State early intervention or special 
education programs, Head Start and day care programs, the Special Supplemental Food 
Program for Women, Infants and Children (WIC) and other nutritional assistance 
programs). For example, a child is screened at age 5 according to your periodicity 

schedule for vision services and is found to have no abnormalities. At age 6, the child is 

referred to the school nurse by a teacher who suspects the child to have a vision problem. 

The screening indicates a problem may exist. If the child is referred to a qualified 
provider of vision care, the services must be covered even though under your periodicity 
schedule vision services may not be required until the child reaches age 7. 

5-20 Rev. 4 

  

   



  

: EARLY AND PERIODIC SCREENING 

( 07-90 DIAGNOSTIC AND TREATMENT SERVICES 5360(Cont.) 
  

: 2. Report only those participants who receive the complete set of activities 

comprising screening services: 

o A comprehensive health and developmental history (including 

assessment of both physical and mental health development); 

0 A comprehensive unclothed physical exam; 

0 Appropriate immunizations according to age and health 

history (unless medically contraindicated at the time); 

0 Laboratory tests (including lead blood level assessment appropriate 

for age and risk factors); and 
0 Health education (including anticipatory guidance). 

Do not report those participants who receive some (but not all) of the screening services, 

or those who receive interperiodic, vision, hearing, or dental services. 

3. The AAP recommended periodicity schedule calls for the following number 

of screening services by age group (or "health supervision" examinations, as the AAP calls 

    

    

them): 
0 Under 1: 5 (at or by 1, 2, 4, 6, and 9 months) : 

0 1-5: 7 (at or by 12, 15, 18, and 24 months, and 3, 4, and 5 

years) 
0 6 - 14: 5 (at or by 6, 8, 10, 12, and 14 years) 

0 15-20: 3 (at or by 16, 18, and 20 years) 

i 4. ‘Therefore, the annual number of screening services visits expected per individual 

and age cohort, are: 
- Visits per 

Age Group Visits Cohorts Cohort Member 

Under 1 5 1 5.0 

1-5 7 5 1.4 

6 -14 5 9 0.5 

15-20 3 6 0.5 

To determine the number of screening services that fully meet the AAP recommendation, 

multiply the visits per cohort member by the estimated number of EPSDT eligibles for 

each cohort. 

3S. The goal is for each State to achieve, within 5 years or by 1995, 80 percent 

of the number of annual screening services expected for each cohort times the number of 

EPSDT eligibles reported for each cohort. No interval goals are set for 1991. We expect 

to refine our instructions based on the first full year's experience with reporting 

| participation in screening services. 

Rev. 4&4 
5-57