Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.19-010 - ARKIDS-3-18 (ARKIDS-B); EPSDT-1-18 (Early and Periodic Screening, Diagnosis, and Treatment) services

Current through Register Vol. 49, No. 6, June, 2024
Section II
ARKids First-B
222.800
Schedule for Preventive Health Screens
The ARKids First - B periodic screening schedule follows the
				guidelines for the EPSDT screening schedule and is updated in accordance with
				the recommendations of the American Academy of Pediatrics.
From birth to 15 months of age, children may receive six (6)
				periodic screens in addition to the newborn screen performed in the
				hospital.
Children age 15 months to 24 months of age may receive two (2)
				periodic screens. Children age 24 months to 30 months may receive one (1)
				periodic screen, and children 30 months to 3 years old may receive one (1)
				periodic screen.
When a child has turned 3 years old, the following schedule
				will apply. There must be at least 365 days between each screen listed below
				for children age 3 years through 18 years.
Age
3 years
7 years
11 years
15 years
4 years
8 years
12 years
16 years
5 years
9 years
13 years
17 years
6 years
10 years
14 years
18 years
Medical screens for children are required to be performed by
				the beneficiary's PCP or receive a PCP referral to an authorized Medicaid
				screening provider. Routine newborn care, vision screens, dental screens and
				immunizations for childhood diseases do not require PCP referral. See Section
				262.130 for procedure codes.
222.810
Newborn Screen (Ages 3 to 5
			 Days)
A. History (initial/interval) to
			 be performed.
B. Measurements to be
			 performed:
1. Height and Weight
2. Head Circumference
C. Physical Examination to be performed at 3
			 to 5 days of age. At each visit a completed physical examination is essential
			 with the infant totally unclothed.
D. Developmental/Surveillance and
			 Psychosocial/Behavioral Assessment, to be performed by history and appropriate
			 physical examination and, if suspicious, by specific objective developmental
			 testing. Parenting skills should be fostered at every visit
E. Procedures-General
These may be modified depending upon the entry point into the
				schedule and the individual need.
1.
			 Hereditary/Metabolic Screening to be performed at age 1 month, if not performed
			 either during the newborn evaluations or at the preferred one of 3-5 days.
			 Metabolic screening (e.g., thyroid, hemoglobinopathies, PKU, galactosemia)
			 should be done according to state law.
2. lmmunization{s) to be performed as
			 appropriate. Every visit should be an opportunity to update and complete a
			 chiid's immunizations.
222.820
Infancy (Ages 1-9
			 Months)
A. History (Initial/Interval)
			 to be performed at ages 1, 2, 4, 6, and 9 months.
B. Measurements to be performed
1. Height and Weight at ages 1,2,4, 6, and 9
			 months.
2. Head Circumference at
			 ages 1,2,4, 6, and 9 months.
C. Sensory Screening, subjective, by history
1. Vision at ages 1,2,4, 6, and 9
			 months.
2. Hearing at ages 1,2,4,
			 6, and 9 months.
D.
			 Developmental/Surveiilance and Psychosocial/Behavioral Assessment to be
			 performed at ages 1, 2, 4, 6, and 9 months; to be performed by history and
			 appropriate physicai examination and, if suspicious, by specific objective
			 developmental testing. Parenting skills should be fostered at every
			 visit.
E. Physical Examination to
			 be performed at ages 1,2,4, 6, and 9 months. At each visit, a complete physical
			 examination is essential with the infant totally unclothed.
F. Procedures - General
These may be modified depending upon the entry point into the
				schedule and the individual need.
1.
			 Hereditary/Metabolic Screening to be performed at age 1 month, if not performed
			 either during the newborn evaluation or at the preferred age of 3-5 days.
			 Metabolic screening (e.g., thyroid, hemoglobinopathies, PKU, galactosemia)
			 should be done according to state law.
2. Immunization(s) to be performed at ages
			 1,2,4, 6, and 9 months. Every visit should be an opportunity to update and
			 complete a child's immunizations.
3. Hematocrit or Hemoglobin risk assessment
			 at 4 months with appropriate testing of high risk factors.
G. Other Procedures
1. Lead screening risk assessment to be
			 performed at ages 6 and 9 months. Additionally, screening should be done in
			 accordance with state law where applicable.
2. Tuberculin surveillance to be performed at
			 ages 1 and 6 months per recommendations of the American Academy of Pediatrics
			 (AAP) Committee on Infectious Diseases, published in the current edition of
AAP Red Book: Report of the Committee on Infectious Diseases.
Testing should be performed on recognition of high risk factors.
H. Anticipatory Guidance to be
			 performed at ages 1, 2, 4, 6, and 9 months. Age-appropriate discussion and
			 counseling should be an integral part of each visit for care.
1. Injury prevention at ages 1,2,4, 6, and 9
			 months.
2. Violence prevention at
			 ages 1,2,4, 6, and 9 months.
3.
			 Sleep positioning counseling at ages 1,2,4, and 6 months. Parents and
			 caregivers should be advised to place healthy infants on their backs when
			 putting them to sleep. Side positioning is a reasonable alternative but carries
			 a slightly higher risk of SIDS.
4.
			 Nutrition counseling at ages 1,2,4, 6, and 9 months. Age-appropriate nutrition
			 counseling should be an Integral part of each visit.
I. Oral Health risk assessment: The Bright
			 Futures/AAP "Recommendation for Preventative Pediatric Health Care," (i.e.
			 Periodicity Schedule) recommends all children receive a risk assessment at the
			 6- and 9-month visits. For the 12-, 18-, 24-, 30-month, and the 3- and 6-year
			 visits, risk assessment should continue if a dental home has not been
			 established.
View the Bright/AAP Periodicity
			 Schedule
Subsequent examinations should be completed as prescribed by
				the child's dentist and recommended by the Child Health Services (EPSDT) dental
				schedule.
J. Developmental
			 Screen to be performed at age 9 months using a standardized tool such as the
			 Ages and Stages Questionnaire (ASQ) or Brigance Screens II. Any additional test
			 must be approved by the Division of Medical Services (DMS) prior to
			 use.
222.830
Early
			 Chiidhood (Ages 12 Months-4 Years
A.
			 History (Initial/lnten/al) to be performed at ages 12, 15, 18, 24, and 30
			 months and ages 3 and 4 years.
B.
			 Measurements to be performed
1. Height and
			 Weight at ages 12, 15, 18, 24, and 30 months and ages 3 and 4 years.
2. Head Circumference at ages 12,15,18, and
			 24 months.
3. Blood Pressure at
			 ages 30 months*, 3 and 4 years.
*Note: For infants and children with specific risk
				conditions.
4. BMI (Body
			 Mass Index) at ages 24 and 30 months, 3 and 4 years.
C. Sensory Screening, subjective, by history
1. Vision at ages 12,15,18, 24, and 30
			 months
2. Hearing at ages 12, 15,
			 18, 24, and 30 months and age 3 years.
D. Sensory Screening, objective, by a
			 standard testing method
1. Vision at ages 3
			 and 4 years. Note: If the 3-year-old patient is uncooperative, re-screen within
			 6 months.
2. Hearing at age 4
			 years.
E.
			 Developmental/Surveillance and Psychosocial/Behavioral Assessment to be
			 performed at ages 12, 15, 18, 24, and 30 months and ages 3 and 4 years. To be
			 performed by history and appropriate physical examination and, if suspicious,
			 by specific objective developmental testing. Parenting skills should be
			 fostered at every visit.
F.
			 Physical Examination to be performed at ages 12, 15, 18, 24, and 30 months and
			 ages 3 and 4 years. At each visit, a complete physical examination is
			 essential, with the infant totally unclothed or with the older child undressed
			 and suitably draped.
G. Procedures
			 - General
These may be modified depending upon the entry point into the
				schedule and the individual need.
1.
			 Immunization(s) to be performed at ages 12, 15, 18, 24, and 30 months and ages
			 3 and 4 years. Every visit should be an opportunity to update and complete a
			 child's immunizations.
2.
			 Hematocrit or Hemoglobin risk assessment at 4 months with appropriate testing
			 and follow up action If high risk to be performed at ages 12, 15, 18, 24, and
			 30 months and ages 3 and 4 years.
H. Other Procedures
Testing should be done upon recognition of high risk
				factors.
1. Lead screening risk
			 assessment to be performed at ages 12 and 24 months. Additionally, screening
			 should be done in accordance with state law where applicable, with appropriate
			 action to follow if high risk positive.
2. Tuberculin test to be performed at ages 12
			 and 24 months and ages 3 and 4 years. Testing should be done upon recognition
			 of high-risk factors per recommendations of the Committee on Infectious
			 Diseases, published in the current edition of
AAP Red Book: Report of
			 the Committee on Infectious Diseases.
Testing should be performed on
			 recognition of high risk factors.
3. Risk Assessment for Hyperlipidemla to be
			 performed at ages 24 months and 4 years with fasting screen, if family history
			 cannot be ascertained, and other risk factors are present, screening should be
			 at the discretion of the physician.
I. Anticipatory Guidance to be performed at
			 ages 12, 15, 18, 24, and 30 months and at ages 3 and 4 years. Age-appropriate
			 discussion and counseling should be an integral part of each visit for care.
1. Injury prevention to be performed at ages
			 12, 15, 18, 24, and 30 months and at ages 3 and 4 years.
2. Violence prevention to be performed at
			 ages 12, 15, 18, 24, and 30 months and at ages 3 and 4 years.
3. Nutrition counseling to be performed at
			 ages 12, 15, 18, 24, and 30 months and ages 3 and 4 years. Age-appropriate
			 nutrition counseling should be an integral part of each visit.
J. Oral Health Risk assessment:
			 The Bright Futures/AAP "Recommendation for Preventative Pediatric Health Care,"
			 {i.e, Periodicity Schedule) recommends all children receive a risk assessment
			 at the 6- and 9-month visits. For the 12-, 18-, 24-, 30-month, and the 3- and
			 6-year visits, risk assessment should continue If a dental home has not been
			 established.
View the Briqht/AAP Periodicity
			 Schedule
.
Subsequent examinations should be as prescribed by the dentist
				and recommended by the Child Health Services (EPSDT) dental schedule.
K. Developmental Screen to be
			 peri'ormed at age 18 and 30 months using standardized tools such as the Ages
			 and Stages Questionnaire (ASQ) or Brigance Screens-ll. Any additional tests
			 must be approved by DMS prior to use.
L. Autism Screen to be peri'ormed at age 18
			 and 24 months (or 30 months if screen was not completed at 24 months) using a
			 standardized tool such as the Modified Checklist for Autism In Toddlers
			 (M-CHAT) or the Pervasive Developmental Disorders Screening Tests-II
			 (PDDSDT-II) Stagel. Any additional test must be approved by DMS prior to
			 use.
222.840
Middle Childhood (Ages 5 -10 Years)
A. History (Initial/Interval) to be performed
			 at ages 5, 6, 7, 8, 9, and 10 years.
B. Measurements to be performed
1. Height and Weight at ages 5, 6, 7, 8, 9,
			 and 10 years.
2. Blood Pressure at
			 ages 5, 6, 7, 8, 9, and 10 years.
3. Body Mass Index at ages 5, 6, 7, 8, 9, and
			 10 years.
C. Sensory
			 Screening, objective, by a standard testing method
1. Vision at ages 5, 6, 8, and 10
			 years.
2. Hearing at ages 5, 6, 8,
			 and 10 years.
D. Sensory
			 Screening, subjective, by history.
1. Vision
			 at ages 7 and 9.
2. Hearing at ages
			 7 and 9.
E.
			 Developmental/Surveillance and Psychosocial/Behavioral Assessment to be
			 performed at ages 5, 6, 7, 8, 9, and 10 years. To be performed by history and
			 appropriate physical examinations and, if suspicious, by specific objective
			 developmental testing. Parenting skills should be fostered at every
			 visit.
F. Physical Examination to
			 be performed at ages 5, 6, 7, 8, 9, and 10 years. At each visit, a complete
			 physical examination Is essential with the child undressed and suitably
			 draped.
G. Procedures - General
These may be modified depending upon entry point into schedule
				and individual need.
1.
			 lmmunization{s) to be performed at ages 5, 6, 7, 8, 9, and 10 years. Every
			 visit should be an opportunity to update and complete a child's
			 immunizations.
2. Hematocrit or
			 Hemoglobin to be performed for patients at high risl< at ages 5, 6, 7, 8, 9,
			 and 10 years.
3. High Cholesterol
			 to be performed at least once between the ages of 9 and 11, using a non-HDL
			 cholesterol test that does not require fasting. Abnormal results should be
			 followed up with a fasting lipid profile.
H. Other Procedures
Testing should be done upon recognition of high-risk
1. Tuberculin test to be performed at ages 5,
			 6, 7, 8, 9,and 10 years. Testing should be done upon recognition of high-risk
			 factors.
2. Risk Assessment for
			 Hyperlipidemia to be performed at ages 6, 7, 8, 9, and 10 years with fasting if
			 family history cannot be ascertained, and other risk factors are present,
			 screening should be at the discretion of the physician.
3. Oral Health Risk Assessment: The Bright
			 Futures/AAP "Recommendation for Preventative Pediatric Health Care," {i.e.
			 Periodicity Schedule) recommends all children receive a risk assessment at the
			 6- and 9-month visits. For the 12-, 18-, 24-, 30-month, and the 3- and 6-year
			 visits, risk assessment should continue if a dental home has not been
			 established. View the
Bright/AAP Periodicity
			 Schedule
.
Subsequent examination should be as prescribed by the dentist
				and recommended by the Child Health Services (EPSDT) dental schedule.
I. Anticipatory
			 Guidance to be performed at ages 5, 6, 7, 8, 9, and 10 years. Age-appropriate
			 discussion and counseling should be an integral part of each visit for care.
1. Injury prevention to be performed at ages
			 5, 6, 7, 8, 9, and 10 years.
2.
			 Violence prevention to be performed at ages 5, 6, 7, 8, 9, and 10
			 years.
3. Nutrition counseling to
			 be performed at ages 5, 6, 7, 8, 9, and 10 years. Age-appropriate counseling
			 should be an integral part of each visit.
222.850
Adolescence (Ages 11 - 18
			 Years)
Developmental, psychosocial and chronic disease issues for
				children and adolescents may require frequent counseling and treatment visits
				separate from preventive care visits.
A. History (Initial/Interval) to be performed
			 at ages 11, 12, 13, 14, 15, 16, 17, and 18 years.
B. Measurements to be performed
1. Height and Weight at ages 11, 12, 13, 14,
			 15, 16, 17, and 18years.
2. Blood
			 Pressure at ages 11, 12, 13, 14, 15, 16, 17, and 18 years.
3. Body Mass Index at ages: 11, 12, 13, 14,
			 15, 16, 17, and 18 years.
C. Sensory Screening, subjective, by history
1. Vision at ages 11,13,14,16, and 17
			 years.
2. Hearing at ages 11, 12,
			 13, 14, 16, 17, and 18 years.
D. Sensory Screening, objective, by a
			 standard testing method
1. Vision at ages
			 12,15, and 18 years.
2. Hearing at
			 ages 12, 15, and 18 years.
E. Developmental/Surveillance and
			 Psychosocial/Behavioral Assessment to be performed at ages 11, 12, 13, 14, 15,
			 16, 17, and 18 years. To be performed by history and appropriate physical
			 examination, if suspicious, by specific objective developmental testing.
			 Parenting skills should be fostered at every visit.
F. Physical Examination to be performed at
			 ages 11, 12, 13, 14, 15, 16, 17, and 18 years. At each visit, a complete
			 physical examination is essential, with the child undressed and suitably
			 draped.
G. Procedures - General
These may be modified, depending upon entry point into schedule
				and individual need.
1.
			 lmmunization(s)to be performed at ages 11, 12, 13, 14, 15, 16, 17, and 18
			 years. Every visit should be an opportunity to update and complete a child's
			 immunizations.
2. High Cholesterol
			 screening to be performed at least once between the ages of 17 and 18, using a
			 non-HDL cholesterol test that does not require fasting. Abnormal results should
			 be followed up with a fasting lipid profile..
H. Other Procedures
Testing should be done upon recognition of high risk
				factors.
1. Tuberculin test to be
			 performed at ages 11, 12, 13, 14, 15,16, 17, and 18 years.
2. Risk assessment for Hyperlipidemia to be
			 performed annually with fasting screen if family history cannot be ascertained
			 and other risk factors are present. Screening should be at the discretion of
			 the physician.
3. Hematocrit or
			 Hemoglobin to be performed for those patients at high risk at ages 11
			 -18.
4. STI/HIV screening to be
			 performed at ages 11, 12, 13, 14, 15, 16, 17, and 18 years. All sexually active
			 patients should be screened for sexually transmitted diseases (STDs).
			 Adolescents should be screened for sexually transmitted infections (STIs) per
			 recommendations in the current addition of
the AAP Red Book: Report of
			 the Committee on Infectious Diseases,
Additionally, all adolescents
			 should be screened for HIV according to the
AAP
			 statement
once between the ages of 16 and 18, making every effort
			 to preserve confidentiality of the adolescent. Those at increased risk of HIV
			 infection, including those who are sexually active, participate in injection
			 drug use, or are being tested for other STIs, should be tested for HIV and
			 reassessed annually
5. Depression
			 screening ages 12 through 18 using screening tools such as Patient Health
			 Questionnaire {PHQ)-2 or other tools available in the GLAD-PC
			 toolkit.
I. Anticipatory
			 Guidance to be performed at ages 11, 12, 13, 14, 15, 16, 17, and 18 years.
			 Age-appropriate discussion and counseling should be an integral part of each
			 visit for care.
1. Injury prevention to be
			 performed at ages 11, 12, 13, 14, 15, 16, 17, and 18 years.
2. Violence prevention to be performed at
			 ages 11, 12, 13, 14, 15, 16, 17, and 18 years.
3. Nutrition counseling to be performed at
			 ages 11, 12,13, 14, 15, 16, 17, and 18 years. Age-appropriate nutrition
			 counseling should be an integral part of each visit.
215.100
Schedule for Child
			 Health Services (EPSDT) Medical/Periodicity Screening
The periodic EPSDT screening schedule has been changed in
				accordance with the most recent recommendations of the American Academy of
				Pediatrics.
From birth to 15 months of age, children may receive six (6)
				periodic screens in addition to the newborn screen performed in the
				hospital.
Children age 15 months to 24 months of age may receive two (2)
				periodic screens. Children age 24 months to 30 months may receive one (1)
				periodic screen, and children 30 months to 3 years old may receive one (1)
				periodic screen.
When a child has turned 3 years old, the following schedule
				will apply. There must be at least 365 days between each screen listed below
				for children age 3 years through 20 years.
Age
3 years
8 years
13 years
18 years
4 years
9 years
14 years
19 years
5 years
10 years
15 years
20 years
6 years
11 years
16 years
7 years
12 years
17 years
Most medical and hearing screens for children require a PCP
				referral before the screens may occur. Routine newborn care, vision screens,
				dental screens and immunizations for childhood diseases do not require PCP
				referral. See Section 242.100 for procedure codes.
215.301
Newborn Screen (Ages 3 to 5
			 Days)
A. History (initial/interval) to
			 be performed.
B. Measurements to be
			 performed
1. Height and Weight
2. Head Circumference
C. Physical Examination to be performed at 3
			 to 5 days of age. At each visit a completed physical examination Is essential
			 with the infant totally unclothed.
D. Developmental/Surveillance and
			 Psychosocial/Behavloral Assessment, to be performed by history and appropriate
			 physical examination and, if suspicious, by specific objective developmental
			 testing. Parenting skills should be fostered at every visit.
E. Procedures-General
These may be modified depending upon the entry point into the
				schedule and the Individual need.
1.
			 Hereditary/Metabolic Screening to be performed at age 1 month, if not performed
			 either during the newborn evaluations or at the preferred age of 3-5 days.
			 Metabolic screening (e.g. thyroid, hemoglobinopathies, PKU, galactosemia)
			 should be done according to state law.
2. Immunization(s) to be performed as
			 appropriate. Every visit should be an opportunity to update and complete a
			 child's immunizations.
215.310
Infancy (Ages 1-9
			 months)
A. History (Initial/Interval)
			 to be performed at ages 1, 2, 4, 6, and 9 months.
B. Measurements to be performed
1. Height and Weight at ages 1,2,4, 6, and 9
			 months.
2. Head Circumference at
			 ages 1,2,4, 6, and 9 months.
C. Sensory Screening, subjective, by history
1. Vision at ages 1,2,4, 6, and 9
			 months.
2. Hearing at ages 1,2,4,
			 6, and 9 months.
D.
			 Developmental/Surveillance and Psychosocial/Behavloral Assessment to be
			 performed at ages 1,2,4, 6, and 9 months. To be performed by history and
			 appropriate physical examination and. If suspicious, by specific objective
			 developmental testing. Parenting skills should be fostered at every
			 visit.
E. Physical Examination to
			 be performed at ages 1, 2, 4, 6, and 9 months. At each visit, a complete
			 physical examination is essential with the Infant totally unclothed.
F. Procedures - General
These may be modified depending upon the entry point into the
				schedule and the individual need.
1.
			 Hereditary/Metabolic Screening to be performed at age 1 month, if not performed
			 either during the newborn evaluation or at the preferred age of 3-5 days.
			 Metabolic screening (e.g., thyroid, hemoglobinopathies, PKU, galactosemia)
			 should be done according to state law.
2. Immunizatlon(s) to be performed at ages
			 1,2,4, 6, and 9 months. Every visit should be an opportunity to update and
			 complete a child's Immunizations.
3. Hematocrit or Hemoglobin risk assessment
			 at age 4 months with appropriate testing of high risk factors.
G. Other Procedures
1. Lead screening risk assessment to be
			 performed at ages 6 and 9 months. Additionally, screening should be done in
			 accordance with state law where applicable.
2. Tuberculin surveillance to be performed at
			 ages 1 and 6 months per recommendations of the American Academy of Pediatrics
			 (AAP) Committee on Infectious Diseases, published in the current edition
of AAP Red Book: Report of the Committee on Infectious
			 Diseases.
Testing should be performed on recognition of high risk
			 factors.
H. Anticipatory
			 Guidance to be performed at ages 1, 2, 4, 6, and 9 months. Age-appropriate
			 discussion and counseling should be an integral part of each visit for care.
1. Injury prevention at ages 1, 2, 4, 6, and
			 9 months.
2. Violence prevention at
			 ages 1,2,4, 6, and 9 months.
3.
			 Sleep positioning counseling at ages 1,2,4, and 6 months. Parents and
			 caregivers should be advised to place healthy Infants on their backs when
			 putting them to sleep. Side positioning is a reasonable alternative but carries
			 a slightly higher risk of SIDS.
4.
			 Nutrition counseling at ages 1,2,4, 6, and 9, months. Age-appropriate nutrition
			 counseling should be an integral part of each visit.
I. .Oral Health Risk Assessment:
The Bright Futures/AAP "Recommendation for Preventative
				Pediatric Health Care," (i.e., Periodicity Schedule) recommends all children
				receive a risk assessment at the 6- and 9-month visits. For the 12-, 18-, 24-,
				30-month, and the 3- and 6-year visits, risk assessment should continue if a
				dental home has not been established.
View the Bright/AAP
				Periodicity Schedule
Subsequent examinations should be completed as prescribed by
				the child's dentist and recommended by the Child Health Services (EPSDT) dental
				schedule.
J. Developmental
			 Screen to be performed at age 9 months using a standardized tool such as the
			 Ages and Stages Questionnaire (ASQ) or Brigance Screens-ll. Any additional test
			 must be approved by DMS prior to use.
215.320
Early Childhood (Ages 12
			 months-4 years)
A. History
			 (Initial/Interval) to be performed at ages 12, 15, 18, 24, and 30* months and
			 ages 3 and 4 years.
B. Measurements
			 to be performed
1. Height and Weight at ages
			 12, 15, 18, 24, and 30 months and ages 3 and 4 years.
2. Head Circumference at ages 12, 15, 18, and
			 24 months.
3. Blood Pressure at 30
			 months* and ages 3 and 4 years
* Note for infants and children with specific risk
				conditions.
4. BMI (Body
			 Mass Index) at ages 24 and 30 months, and ages 3 and 4 years.
C. Sensory Screening, subjective,
			 by history
1. Vision at ages 12,15,18, 24,
			 and 30 months
2. Hearing at ages
			 12, 15, 18, 24, and 30 months and age 3 years.
D. Sensory Screening, objective, by a
			 standard testing method
1. Vision at ages 3
			 and 4 years. Note: If the 3-year-old patient is uncooperative, re-screen within
			 6 months.
2. Hearing at age 4
			 years.
E.
			 Developmental/Surveillance and Psychosocial Behavioral Assessment to be
			 performed at ages 12, 15, 18, 24, and 30 months and ages 3 and 4 years. To be
			 performed by history and appropriate physical examination and, if suspicious,
			 by specific objective developmental testing. Parenting skills should be
			 fostered at every visit.
F.
			 Physical Examination to be performed at ages 12, 15, 18, 24, and 30 months and
			 3 and 4 years. At each visit, a complete physical examination is essential,
			 with the infant totally unclothed or with the older child undressed and
			 suitably draped.
G. Procedures -
			 General
These may be modified depending upon the entry point into the
				schedule and the individual need.
1.
			 lmmunization{s)to be performed at ages 12, 15, 18, 24, and 30 months and 3 and
			 4 years. Every visit should be an opportunity to update and complete a child's
			 immunizations.
2. Hematocrit or
			 Hemoglobin risk assessment at 4 months with appropriate testing and follow up
			 action if high risk to be performed at ages 12, 15, 18, 24, and 30 months and
			 ages 3 and 4 years.
H.
			 Other Procedures
Testing should be done upon recognition of high risk
				factors.
1. Lead screening risk
			 assessment to be performed at ages 12 and 24 months. Additionally, screening
			 should be done in accordance with state law where applicable, with appropriate
			 action to follow if high risk positive.
2. Tuberculin test to be performed at ages 12
			 and 24 months and ages 3 and 4 years. Testing should be done upon recognition
			 of high-risk factors per recommendations of the Committee on Infectious
			 Diseases, published in the current edition of
AAP Red Book: Report of
			 the Committee on Infectious Diseases.
Testing should be performed on
			 recognition of high risk factors.
3. Risk Assessment for Hyperlipidemia to be
			 performed at ages 24 months and 4 years with fasting screen. If family history
			 cannot be ascertained and other risk factors are present, screening should be
			 at the discretion of the physician.
I. Anticipatory Guidance to be performed at
			 ages 12, 15, 18, 24, and 30 months and at ages 3 and 4 years. Age-appropriate
			 discussion and counseling should be an integral part of each visit for care.
1. Injury prevention to be performed at ages
			 12, 15, 18, 24, and 30 months and at 3 and 4 years.
2. Violence prevention to be performed at
			 ages 12,15,18, 24, and 30 months and at 3 and 4 years.
3. Nutrition counseling to be performed at
			 ages 12 15, 18, 24, and 30 months and 3 and 4 years. Age-appropriate nutrition
			 counseling should be an integral part of each visit.
J. Oral Health Risk Assessment:
The Bright Futures/AAP "Recommendation for Preventative
				Pediatric Health Care," {i.e., Periodicity Schedule) recommends all children
				receive a risk assessment at the 6- and 9-month visits. For the 12-, 18-, 24-,
				30-month, and the 3- and 6-year visits, risk assessment should continue if a
				dental home has not been established.
View the Bright/AAP
				Periodicity Schedule
Subsequent examinations should be as prescribed by the dentist
				and recommended by the Child Health Services (EPSDT) dental
				schedule.
K. Developmental
			 Screen to be performed at ages 18 months and 30 months using standardized tools
			 such as the Ages and Stages Questionnaire (ASQ) or Brigance Screens-ll. Any
			 additional tests must be approved by DMS prior to use.
L. Autism Screen to be performed at ages 18
			 and 24 months (or 30 months if screen was not completed at 24 months) using a
			 standardized tool such as the Modified Checklist for Autism in Toddlers
			 (M-CHAT) or the Pervasive Developmental Disorders Screening Tests-II
			 (PDDSDT-II) Stagel. Any additional test must be approved by DMS prior to
			 use.
215.330
Middle
			 Childhood (Ages 5-10 years)
A. History
			 (Initial/Interval) to be performed at ages 5, 6, 7, 8, 9, and 10
			 years.
B. Measurements to be
			 performed
1. Height and Weight at ages 5, 6,
			 7, 8, 9, and 10 years.
2. BMI (Body
			 Mass Index) at all ages.
3. Blood
			 Pressure at ages 5, 6, 7, 8, 9, and 10 years.
C. Sensory Screening, objective, by a
			 standard testing method.
1. Vision at ages 5,
			 6, 8, and 10 years.
2. Hearing at
			 ages 5, 6, 8, and 10 years.
D. Sensory Screening, subjective, by history.
1. Vision at ages 7 and 9.
2. Hearing at ages 7 and 9.
E. Developmental/Surveillance and
			 Psychosocial Behavioral Assessment to be performed at ages 5, 6, 7, 8, 9, and
			 10 years. To be performed by history and appropriate physical examinations and,
			 if suspicious, by specific objective developmental testing. Parenting skills
			 should be fostered at every visit.
F. Physical Examination to be performed at
			 ages 5, 6, 7, 8, 9, and 10 years. At each visit, a complete physical
			 examination is essential with the child undressed and suitably
			 draped.
G. Procedures - General
These may be modified depending upon entry point into schedule
				and individual need.
1.
			 Immunizatlon(s) to be performed at ages 5, 6, 7, 8, 9, and 10 years. Every
			 visit should be an opportunity to update and complete a child's
			 immunizations.
2. Hematocrit or
			 Hemoglobin to be performed for patients at high risk at age 5, 6, 7, 8, 9, and
			 10 years.
3. High Cholesterol
			 screening to be performed at least once between the ages of 9 and 11, using a
			 non-HDL cholesterol test that does not require fasting. Abnormal results should
			 be followed up with a fasting lipid profile.
H. Other Procedures
Testing should be done upon recognition of high-risk
				factors.
1. Tuberculin test to be
			 performed at ages 5, 6, 7, 8, 9, and 10 years. Testing should be done upon
			 recognition of high-risk factors.
2. Risk Assessment for Hyperlipidemia to be
			 performed at ages 6, 7, 8, 9, and 10 years with fasting. If family history
			 cannot be ascertained and other risk factors are present, screening should be
			 at the discretion of the physician.
3. Oral Health Risk Assessment;
The Bright Futures/AAP "Recommendation for Preventative
				Pediatric Health Care," (i.e.. Periodicity Schedule) recommends all children
				receive a risk assessment at the 6- and 9-month visits. For the 12-, 18-, 24-,
				30-month, and the 3- and 6-year visits, risk assessment should continue if a
				dental home has not been established.
View the Bright/AAP
				Periodicity Schedule
Subsequent examination should be as prescribed by the dentist
				and recommended by the Child Health Services (EPSDT) dental
				schedule.
I.
			 Anticipatory Guidance to be performed at ages 5, 6, 7, 8, 9, and 10 years.
			 Age-appropriate discussion and counseling should be an integral part of each
			 visit for care.
1. Injury prevention to be
			 performed at ages 5, 6, 7, 8, 9, and 10 years.
2. Violence prevention to be performed at
			 ages 5, 6, 7, 8, 9, and 10 years.
3. Nutrition counseling to be performed at
			 ages 5, 6, 7, 8, 9, and 10 years. Age-appropriate counseling sinould be an
			 integral part of each visit.
215.340
Adolescence (Ages 11-20
			 years)
Developmental, psychosocial and chronic disease issues for
				children and adolescents may require frequent counseling and treatment visits
				separate from preventive care visits.
A. History (Initial/Interval) to be performed
			 at ages 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 years.
B. Measurements to be performed
1. Height and Weight at ages 11, 12, 13, 14,
			 15, 16, 17, 18, 19, and 20 years.
2. Blood Pressure at ages 11, 12, 13, 14, 15,
			 16, 17, 18, 19, and 20 years.
3.
			 BMI (Body Mass Index) at all ages.
C. Sensory Screening, subjective, by history
1. Vision at ages 11, 13, 14, 16, 17, 19, and
			 20 years.
2. Hearing at ages 11,
			 12, 13, 14, 16, 17, 18, 19, and 20years.
D. Sensory Screening, objective, by a
			 standard testing method
1. Vision at ages
			 12,15, and 18 years.
2. Hearing at
			 ages 12, 15, and 18 years.
E. Developmental/ Surveillance and
			 Psychosocial/Behavioral Assessment to be performed at ages 11, 12, 13, 14, 15,
			 16, 17, 18, 19, and 20 years. To be performed by history and appropriate
			 physical examination, If suspicious, by specific objective developmental
			 testing. Parenting skills should be fostered at every visit.
F. Physical Examination to be performed at
			 ages 11, 12, 13,14, 15, 16, 17, 18, 19, and 20 years. At each visit, a
			 coriiplele physical examinalion is essential, with the child undressed and
			 suitably draped.
G. Procedures -
			 General
These may be modified, depending upon entry point into schedule
				and Individual need.
1.
			 lmmunization(s)to be performed at ages 11, 12, 13, 14, 15, 16, 17, 18, 19, and
			 20 years. Every visit should be an opportunity to update and complete a child's
			 immunizations.
2. High Cholesterol
			 screening to be performed at least once between the ages of 17 and 21, using a
			 non-HDL cholesterol test that does not require fasting. Abnormal results should
			 be followed up with a fasting lipid profile.
H. Other Procedures
Testing should be done upon recognition of high risk
				factors.
1. Tuberculin test to be
			 performed at ages 11, 12, 13, 14, 15,16, 17, 18, 19, and 20 years.
2. Risk assessment for Hyperlipidemia to be
			 performed annually with fasting screen if family history cannot be ascertained
			 and other risk factors are present. Screening should be at the discretion of
			 the physician.
3. Sexually
			 Transmitted Infection (STI) screening to be performed at ages 11, 12, 13, 14,
			 15, 16, 17, 18, 19, and 20 years. All sexually active patients should be
			 screened. Hematocrit or Hemoglobin to be performed for those patients at high
			 risk at ages 11-20 years.
4. HIV
			 screening to be performed one time between ages 15 and 18 years. Additionally,
			 all adolescents should be screened for HIV, making every effort to preserve
			 confidentiality of the adolescent, according to the AAP statement.
View the AAP screening statement
.
Those
			 at increased risk of HIV infection, including those who are sexually active,
			 participate in injection drug use, or are being tested for other STIs, should
			 be tested for HIV and reassessed annually.
5. Depression screening to be performed each
			 year between ages 12 through 20 using screening tools such as the Patient
			 Health Questionnaire (PHQ)-2 or other tools available in the Guidelines for
			 Adolescent Depression in Primary Care (GLAD-PC) toolkit.
I. Anticipatory Guidance to be performed at
			 ages 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 years. Age-appropriate
			 discussion and counseling should be an Integral part of each visit for care.
1. Injury prevention to be performed at ages
			 11, 12, 13, 14, 15, 16,17, 18, 19, and 20 years.
2. Violence prevention to be performed at
			 ages 11, 12,13, 14, 15, 16, 17, 18, 19, and 20 years.
3. Nutrition counseling to be performed at
			 ages 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 years. Age-appropriate
			 nutrition counseling should be an integral part of each visit.