Code part EVALUATION NOT CO: Commendation EVALUATION ITEM N/A MECHAMISM MET MET COMMENTS KEY: R: Recommendation Quarterly RQ: Required (typed bold) Reports IV. EPSDT/Well Child Exams Are written policies/protocols in place at the agency outlining what steps to follow for Code Policy/ abnormal findings on EPSDT exams and Contract Procedure/ developmental screenings performed by Protocol nurses? Standing orders Code present? Does the agency have written standing Contract orders signed by the medical director, allowing the nurses to do EPSDT exams Code under his/her authority? Contract Healthy Kids Manual Certificate of YES, Agency is billing Medicaid for EPSDT? completion for 1a. Physical Assessments are completed IDHS Pediatric by a Registered Nurse who has completed Assessment the IDHS Pediatric Assessment Course or Course on file a similar course approved by IDHS at each for RN(s) Healthy Kids visit. Manual NO, Agency is NOT billing Medicaid. Code 1b. Physical assessments are completed Contract Policy/ by a Registered Nurse who has knowledge Healthy Kids Procedure/ in pediatric assessment skills at each visit. Manual Protocol
EVALUATION ITEM Code part Quarterly Reports EVALUATION MECHAMISM MET NOT MET N/A CO: Commendation COMMENTS KEY: R: Recommendation RQ: Required (typed bold) IV. EPSDT/Well Child Exams Are written policies/protocols in place at the agency outlining what steps to follow for abnormal findings on EPSDT exams and developmental screenings performed by nurses? Code Contract Code Contract Code Contract Healthy Kids Manual Healthy Kids Manual Code Contract Healthy Kids Manual Policy/ Procedure/ Protocol Standing orders present? Certificate of completion for IDHS Pediatric Assessment Course on file for RN(s) Policy/ Procedure/ Protocol Does the agency have written standing orders signed by the medical director, allowing the nurses to do EPSDT exams under his/her authority? YES, Agency is billing Medicaid for EPSDT? 1a. Physical Assessments are completed by a Registered Nurse who has completed the IDHS Pediatric Assessment Course or a similar course approved by IDHS at each visit. NO, Agency is NOT billing Medicaid. 1b. Physical assessments are completed by a Registered Nurse who has knowledge in pediatric assessment skills at each visit.
FY17_FCM_Clinical_Review_Tool.docx