PARTNERSHIP HEALTHPLAN OF CALIFORNIA
POLICY/ PROCEDURE
Guideline/Procedure Number: HKQG1050 (previously
MPQG1050 & KK QI202)
Guideline/Procedure Title: Pediatric Preventive Health for
Commercial Members
Original Date: 11/16/2005 – Healthy
Kids
Lead Department: Health Services
☒External Policy
☐ Internal Policy
Next Review Date: 11/18/2016
Last Review Date: 11/18/2015
Applies to:
☐ Medi-Cal
☒ Healthy Kids
☐ Employees
Reviewing
Entities:
☒ IQI
☐P&T
☒ QUAC
☐ OPERATIONS
☐ EXECUTIVE
☐ COMPLIANCE
☐ DEPARTMENT
☐ BOARD
☐ COMPLIANCE
☐ FINANCE
☒ PAC
☐ CREDENTIALING
☐ DEPT. DIRECTOR/OFFICER
Approving
Entities:
☐ CEO
☐ COO
Approval Signature: Robert Moore, MD, MPH
Approval Date: 11/18/2015
I.
RELATED POLICIES:
A. MPQP1022 - PCP Facility Site Review
II.
IMPACTED DEPTS:
A. Quality Improvement
III.
DEFINITIONS:
A. N/A
IV.
ATTACHMENTS:
A. N/A
V.
PURPOSE:
To specify PHC policy for periodic health screening and preventive health services for members through 18
years of age provided by primary care providers using the American Academy of Pediatrics (AAP)
preventive health care recommendations, as well as the AICP/AAP immunization schedule, in formulating
plan specific standards and guidelines.
VI.
GUIDELINE / PROCEDURE:
A. The following standards and guidelines address periodic health screening and preventive services for low
risk, asymptomatic children and adolescents. Individuals identified as being at high risk for a given
condition may require screening at more frequent intervals or the performance of additional screening
tests specific to the condition. High risk individuals are defined as those whose risk behaviors, family
history, socioeconomic status, or life style is associated with a higher tendency to the development of a
specific condition or disease.
B. PCPs who provide periodic health screening to members under 18 years old must adhere to the
periodicity and content of the current AAP “Recommendations for Preventive Adolescent/Pediatric
Care”.
C. In addition to the content of the AAP guidelines and sample visit documentation forms in linkReference A, additional recommendations must be addressed at each health screening visit:
1. Calculate and plot BMI percentage once a year in all children and adolescents. Use change in BMI
to identify rate of excessive weight gain relative to linear growth. Documentation must include a
note indicating the date on which the BMI percentile was documented and evidence of either of the
Page 1 of 3
Guideline/Procedure Number: HKQG1050 (previously
Lead Department: Health Services
MPQG1050 & KK QI202)
Guideline/Procedure Title: Pediatric Preventive Health for ☒ External Policy
Commercial Members
☐ Internal Policy
Original Date: 11/16/2005 – Healthy Next Review Date: 11/18/2016
Kids
Last Review Date: 11/18/2015
Applies to: ☐ Medi-Cal
☒ Healthy Kids
☐ Employees
following: BMI percentile or BMI plotted on age growth chart. For adolescents 16-18 years on the
date of service, documentation of a BMI value expressed as kg/m2 is acceptable.
2. Assessment of nutritional status.
3. Dental screening, including inspection of the mouth, teeth, and gums. PCPs must refer children to a
dentist annually, starting at age one.
4. Tobacco smoking history or exposure
a. Exposure to passive (second-hand) smoke
b. Tobacco used by patient
c. Counsel regarding, or referral, for tobacco use prevention or cessation.
D. PCPs must endeavor to complete an initial health assessment within 120 days of enrollment as a PHC
member unless it has been determined by the PCP practice that the member’s medical records contain
complete and current information consistent with the health assessment criteria stated above.
E. Immunizations must be provided according to the current schedule of the Advisory Committee on
Immunization Practices (AICP), AAP, and the American Academy of Family Physicians (AAFP), as
provided in “Recommended Childhood Immunization Schedule,” link -Reference B.
1. When immunizations are provided at sites other than the PCP’s office, the provider should notify the
PCP’s office of the immunization given and the date.
2. If this is not possible, the member or parent/guardian of the member must be advised to provide this
information to the PCP at the next visit.
3. PCP office should be requesting previous medical record(s) to show a complete history.
F. Unless the member has received a periodic health screening visit within the periodicity schedule, in link
A, the member, or the member’s parent/guardian, must be informed at the time of each non-emergency
primary care visit of the availability of services through the PCP’s practice.
1. Should the member not receive periodic health screening services according to the attached
schedule, either:
a. The voluntary refusal of the member (or the parent/guardian) regarding the use of services
should be documented in the member’s medical record, or:
b. There should be documentation of an outbound phone call or written communication from the
provider to the member advising of the need to schedule a periodic health screening
appointment.
2. In the case where a child scheduled for a periodic health screening visit is not seen as scheduled, the
PCP’s staff should contact the member (or parent/guardian) to reschedule the visit, and document
same in the medical record.
G. Diagnosis and treatment of any medical conditions identified through the periodic health screening
process, either by the PCP or through referral to a specialist, must be initiated within 60 days of
identification. Justification for delays beyond 60 days must be entered into the member’s medical record.
H. Providers must enter their findings in the member’s medical record
I.
Parents of children found to have conditions which could constitute eligibility for the California
Children’s Services (CCS) Program must be informed. The PCPs staff MUST initiate a referral to the
county CCS office for eligibility determination.
J.
Monitoring and Quality management
1. Timeliness and appropriateness of pediatric preventive health will be monitored annually by
Page 2 of 3
Guideline/Procedure Number: HKQG1050 (previously
Lead Department: Health Services
MPQG1050 & KK QI202)
Guideline/Procedure Title: Pediatric Preventive Health for ☒ External Policy
Commercial Members
☐ Internal Policy
Original Date: 11/16/2005 – Healthy Next Review Date: 11/18/2016
Kids
Last Review Date: 11/18/2015
Applies to: ☐ Medi-Cal
☒ Healthy Kids
☐ Employees
completing designated HEDIS measures (Childhood Immunization, Adolescent Immunization, Well
Child Visits in the third, fourth, fifth and sixth years of life, Well Child Visits in the First 15 Months
of Life).
2. Documentation of children’s/adolescent preventive services will be reviewed periodically as a
component of the Facility Site Review.
VII.
REFERENCES:
A. AAP Recommendations for Preventive Adolescent/Pediatric Care:
Access all recommendations on line for free from the links found on:
http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html
B. CDC Recommended Childhood and Adolescent Immunization and Catch-Up Schedule, access current
version from link found at:
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
VIII.
DISTRIBUTION:
A. PHC Department Directors
B. Provider Manual
IX.
POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE: Manager of Quality Compliance
X.
REVISION DATES:
Healthy Kids
8/18/10, 10/1/10, 1/16/13, 10/16/13, 11/19/14; 11/18/15
Healthy Families
10/01/2010 to 03/01/2013
PREVIOUSLY APPLIED TO:
MPQG1050 – 10/01/2010 to 03/01/2013
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