HealthCheck Provider Education System

HealthCheck Training

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Overview

Health Supervision

Special Health Issues

Documentation

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Overview

HealthCheck Program Summaries: Coordination

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Federal legislation requires state programs that provide the EPSDT benefit to coordinate with child health related programs to maximize access to services, prevent duplication, and ensure health care for children. These programs include:

Coordination can play an important role in assisting with outreach activities. Some examples of coordinated outreach activities/programs:

 

Healthy Start Project

HealthCheck coordinates with the Healthy Start Project to ensure that members receive counseling, transportation, scheduling, and other necessary support services as a part of comprehensive health care.

 

WIC and Commodity Supplemental Food Programs

Providers are required to refer Medicaid families found to be at nutritional risk to the WIC Program and the Commodity Supplemental Food Program (CSFP).

  • For assistance in making referrals or requesting copies of referral forms, call (202) 645-5663.

 

DC Healthy Families

The State Children’s Health Insurance Program (SCHIP) (called DC Healthy Families) expands Medicaid eligibility to families and children with incomes up to 200% of the federal poverty level. DC Healthy Families has an active outreach and enrollment program.

  • For further information about enrolling in DC Healthy Families, contact (202) 526-6266.

 

Outreach

The Role of the DC Department of Health Care Finance

DHCF identifies eligible children and families in order to:

  • Encourage their participation in Medicaid/HealthCheck.
  • Inform them of the availability and benefits of preventive services.
  • Provide assistance with scheduling appointments and transportation.
  • Help families use health resources effectively and efficiently.
  • Monitor and evaluate the quality of services provided to beneficiaries.

 

The Role of the Income Maintenance Administration (IMA)

*The Commission on Social Service/IMA provides information to the Medicaid applicants about HealthCheck screening services during the initial Medicaid eligibility interview and through the subsequent recertification process.

 

The Role of Managed Care Organizations (MCOs)

MCOs should distribute HealthCheck information to members who select or who are assigned to the MCO.

MCOs shall conduct outreach activities to assist HealthCheck-eligible enrollees keep well-child appointments, including:

  • Appointment reminders (phone or mail)
  • Personal home visit, where feasible, if there is still no response
  • Direct contact with adolescents, when appropriate

MCOs are also expected to coordinate their enrollees’ health care with the following child health related groups:

  • DC Public Schools (DCPS), Department of Special Education
  • Department of Human Services (DHS), DC Early Intervention Program
  • DHS, Administration for Child and Family Services
  • Head Start
  • Department of Mental Health
  • Maternal and Family Health Services
  • Others as appropriate

 

The Role of the Provider

All Medicaid service providers are required to give written and oral EPSDT notice to eligible children and families.

At the first visit

  • Give written materials describing EPSDT services in simple terms to all eligible recipients including:
    • pregnant women
    • parents
    • child custodians
    • teens
    • all individuals who are blind or deaf, or who are illiterate

At subsequent visits

  • Continue to provide eligible children and families with written materials describing EPSDT services in simple terms (unless the provider has given such material within the preceding year).

Annually

  • Provide an oral explanation of the EPSDT benefit to all eligible recipients who use Medicaid services during the year.

 

This concludes the Overview section.

Move on to the next section, Health Supervision.

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