New York State 2019-2021 Kids Quality Agenda Performance Improvement Project (PIP)
The first years of a child’s life are a time of rapid development. It is important to identify conditions that could adversely affect development as early as possible. The New York State Department of Health (NYSDOH) recognizes the importance of preventive care during this period in the Medicaid and Child Health Plus (CHP) pediatric populations. That recognition is the foundation for the Kids Quality Agenda Performance Improvement Project (PIP). This PIP incorporates three focus areas:
- Blood lead testing and follow-up
- Newborn hearing screening and follow-up
- Developmental screening
Blood Lead Testing and Follow-up
Medicaid Blood Lead Testing Guidelines
The Centers for Medicare & Medicaid Services (CMS) require that all children enrolled in Medicaid receive blood lead testing at ages 12 months and 24 months. Also, Medicaid-enrolled children older than 24 months but younger than 72 months without a blood lead test on record must receive one. Completion of a lead risk assessment questionnaire does not satisfy this requirement [CMS, 2016]. In addition, NYS law mandates that all children receive blood lead tests twice prior to turning three years old, once around age one and again around age two [NYS, 2009].
Updates to Definition of an Elevated Blood Lead Level (BLL)
The NYS Public Health Laws were recently amended to lower the definition of an elevated BLL in a child to 5 micrograms per deciliter (ug/dl), previously 10 ug/dl, effective on October 1, 2019.
- Children should receive a blood lead test around age one
- Children should also receive a blood lead test around age two
- Children who have a capillary BLL ≥5mcg/dl should have a confirmatory venous test within three months
- Children who have a confirmed venous BLL ≥5mcg/dl should have a follow-up venous blood lead test within three months
Newborn Hearing Screening and Follow-up
The National Center for Hearing Assessment and Management (NCHAM) estimates three out of every 1,000 newborns in the US have permanent hearing loss. If hearing loss is undetected, it can lead to delayed speech, language, social, and emotional development. It is critical that providers review the results of every newborn hearing test conducted, including at the birthing facility, to ensure newborns who did not pass their initial screening have a follow-up or diagnostic audiological exam.
- Newborns should have a hearing screening by one month of age
- Pediatricians should confirm the results of all their patients’ newborn hearing screenings at their initial visit
- Diagnostic audiological evaluation should be performed by three months of age if the newborn did not pass the initial hearing screening
- Newborns diagnosed with hearing loss should be referred to Early Intervention (EI) services by six months of age
Evidence suggests that many children are not identified with developmental delays until they begin school. Children insured by Medicaid are twice as likely to be at risk for developmental delays. Other risk factors include pre-term birth, low birth weight, and prenatal alcohol or drug exposure.
The American Academy of Pediatrics (AAP) recommends routine screening with a standardized developmental screening tool at nine, 18, and 30 months to identify areas of a child’s development that differ from age-specific norms.
Developmental surveillance should also be completed at every provider visit to monitor children who may be at risk for developmental delays.
The prevalence of autism spectrum disorders (ASDs) in 11 surveillance states was 2 in 59 children aged 8 years in 2014. (Baio, MMWR 2018; AAP 2007)
The AAP recommends formal autism screening with a validated autism-specific tool at 18 and 24 months to monitor for developmental regression.
Developmental and Autism Specific Screening Coding
To effectively track global developmental and autism-specific screenings, NYS requests that providers bill to the following CPT codes:
- 96110 code for global developmental screening with a standardized screening tool
- 96110 with CG modifier for autism-specific screening with a standardized screening tool