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​PROVIDER MANUAL

 

 

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Title PageMISSION & GOAL OF THE PROGRAM2016
Section 1INTRODUCTION: MARYLAND HEALTHY KIDS/EPSDT PROGRAM2016
AOverview2016
BHealthy Kids Program Administration2015
CProvider Certification & Qualifications2016
DLocal Health Departments' Role2014
EManaged Care Organizations2016
FHealthy Kids Program Performance Improvement Standards2014
GHIPAA Privacy2014
Section 1ADDENDUM2016
1.1Provider Application for Certification & Participation2017
1.2Provider Certification Letter2015
1.3Provider Action Grid for MCO Newborn Coordinators2003
1.4HIPAA Letter by Maryland Attorney General2003
Section 2MARYLAND EPSDT PREVENTIVE HEALTH CARE SCHEDULE2016
AInitial Screening Services2016
BPeriodic Screening Services2016
CAdditional Screening Services2016
DHearing, Vision & Dental Screening Services2016
ERequired EPSDT Components of the Maryland Healthy Kids Program2016
Section 2ADDENDUM: MARYLAND HEALTHY KIDS PREVENTIVE HEALTH SCHEDULE2016
Section 3 HEALTHY KIDS SCREENING COMPONENTS2017
AHealth and Developmental History2016
BComprehensive Physical Examination Requirement2016
CLaboratory Tests2016
DImmunizations2017
EHealth Education Anticipatory Guidance2016
Section 3CHARTS AND TABLES2016
Chart 1Primary Teeth Eruption2015
Chart 2Permanent Tooth Eruption2015
Table 1Girls Systolic BP by Age & Height2015
Table 2Boys Systolic BP by Age & Height2015
Table 3Dietary Fluoride Supplement Dosage Schedule2014
Table 4DHMH List of Disorders on the Newborn Screen2016
Table 5Hematocrit & Hemoglobin Values for Children2015
Table 6MD Elevated Blood Lead Diagnostic & Follow-up Schedule for Children2014
Table 7MD Department of Environment: Case Coordination Guidelines for Lead Poisoned Children2014
Table 8Targeted Testing & Treatment of Latent TB Infection2014
Table 9Tuberculin Skin Test Cut-Points by Age for Low Risk Persons2014
Table 10Regimens for Treatment of Latent TB Infections2014
Table 11Classification of Cholesterol Levels in Children and Adolescents2014
Section 3ADDENDUM2016
3.1Developmental Screening Tools2014
3.2Additional Evaluation & Intervention for Developmental Disorders2014
3.3Modified Checklist for Autism in Toddlers-Revised, with Follow up (MCHAT-R/F)2015
3.4Early Hearing Detection & Intervention Guide2015
3.5Jaeb Visual Acuity Screener2016
3.6MD WIC Program Medical Documentation Form2015
3.7Expert Committee Recommendations for the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity-2007-An Implementation Guide from the Childhood Obesity Action Network2007
Section 4ADOLESCENT PREVENTIVE HEALTH2016
AA. Introduction2016
BB. Health and Developmental History2015
CC. Comprehensive Physical Examination2015
DD. Laboratory Tests2016
EE. Immunizations2016
FHealth Education and Anticipatory Guidance2015
Section 4ADDENDUM2015
4.1HEEADSSS Psychosocial Interview2015
4.2Identify and Treat Adolescent Depression2010
4.3Patient Health Questionnaire Modified for Teens (PSC-Y)2015
4.4Pediatric Symptoms Checklist for Teens (PHQ-9 Modified)2015
4.5Informed Consent to HIV Testing (English & Spanish)2007
Section 5OTHER CHILD HEALTH-RELATED SERVICES2016
AExpanded EPSDT-Related Services2016
BHealthChoice Self-Referred Services2016
CChildren in State-Supervised Care2016
DOther Programs for Children2016
EDental Care2015
FPublic Mental Health System (PMHS)2016
Section 5ADDENDUM2016
5.1Maryland Uniform Consultation Referral Form2015
5.2School-Based Health Center Health Visit Report Form2015
5.3Local Infants and Toddlers Referral and Feedback Form2009
5.4Local Health Services Request Form2015
5.5Instructions for Use of Local Health Services Request Form2015
5.6REM Intake Application2015
Section 6BILLING AND ENCOUNTER DATA REPORTING2017
AIntroduction2015
BEligibility Verification2015
CGeneral Rules for Medical Assistance Billing2016
DBilling for Fluoride Varnish Application as Part of the EPSDT Preventive Care Visit2016
EBilling for Vaccines for Children Program2017
FBilling for Services in State-supervised Care2015
GBilling for Services to Children in Managed Care Organizations (MCOs)2015
HBilling for Services to Children Non in MCO (Fee-For-Service)2017
ICMS-1500 Billing Instructions2016
Section 7APPENDICES2016
7.1APPENDIX: PREVENTIVE CARE FORMS2015
7.1.1Age Specific Encounter Forms2014
7.1.2Body Mass Index (BMI) Calculator-Child and Teen2016
7.1.3WHO & CDC Growth Charts2014
7.1.4Medical Family History Questionnaire (English)2006
7.1.5Medical Family History Questionnaire (Spanish)2006
7.1.6Objective Hearing and Vision Testing Forms2016
7.2APPENDIX:RISK ASSESSMENT FORMS2016
7.2.1CRAFT Adolescent Substance Abuse Assessment (English)2014
7.2.2CRAFT Adolescent Substance Abuse Assessment (Spanish)2014
7.2.3Mental Health Questionnaires (English & Spanish)2014
7.2.4Nutrition Questionnaires (Infant, Child, Adolescent)2014
7.2.5Preventive Screen Questionnaire: Lead, TB, Anemia, Cholesterol & STD/HIV (English)2017
7.2.6Preventive Screen Questionnaire: Lead, TB, Anemia, Cholesterol & STD/HIV (Spanish)2017
7.2.7SEEK Questionnaire (Abuse Assessment) (English)2014
7.2.8SEEK Questionnaire (Abuse Assessment) (Spanish)2014
7.2.9Victimization Scale (English)2015
7.2.10Victimization Scale (Spanish)2015
7.3APPENDIX: IMMUNIZATION FORMS & RESOURCES2017
7.3.1Maryland Immunization Certification Form2014
7.3.2Maryland Recommended Childhood & Adolescent Immunization Schedules2019
7.3.3Maryland Combination Vaccines Schedule2017
7.3.4Parental Delegation Form for Minors2015
7.3.5VFC Vaccine Inventory Form2015
7.3.6VFC Log of Children Receiving VFC Vaccines2013
7.3.7Patient Eligibility Screening Record2015
7.3.8VFC Program Contact Center2016
7.3.9VFC Vaccine Administration Record2017
7.3.10VFC Vaccine Return & Wastage Form2015
7.3.11Temperature Log for Refrigerator-Celsius2017
7.3.12Temperature Log for Refrigerator-Fahrenheit2017
7.3.13Temperature Log for Freezer-Celsius2017
7.3.14Temperature Log for Freezer-Fahrenheit2017
7.4APPENDIX: HEALTH EDUCATION MATERIALS2017
7.4.1Zika-Information-Flyer2017
7.4.2MDH Zika Factsheet2017
7.4.3Communicative Diseases Factsheet2011
7.4.4General Child Seat Use & MD Child Safety Seat Law2013
7.4.5My Plate2015
7.4.6National Safe Kids Campaign Materials-Bike2013
7.4.7National Safe Kids Campaign Materials-Fire2013
7.4.8National Safe Kids Campaign Materials-Gun2013
7.4.9National Safe Kids Campaign Materials-Poison2014
7.4.10National Safe Kids Campaign Materials-Water2013
7.4.11CDC Tuberculosis Training Materials Order Form2015
7.4.12Center for Immunization Health Education Materials Order Form2014
7.4.13DHMH Office of Oral Health Printed Materials Request Form2015
7.4.14HIV/AIDS Prevention Materials Order Form2015
7.4.15Kids in Safety Seats Education Materials Order Form2013
7.4.16Lead Poisoning Prevention Program Educational Materials Order Form2008
7.4.17Maternal & Child Health Bureau Publication Order Form2013
Section 8TELEPHONE DIRECTORIES2016
AHealthy Kids Consultants2017
BLocal Departments of Social Services2014
CLocal Domestic Violence Directory2014
DLocal Health Departments Administrative Care Coordination Units2014
ELocal Health Departments Children's Health Program (MCHP)2015
FLocal Health Departments Nursing Lead Contacts2014
GLocal Health Departments TB Control Coordinators2014
HLocal Protective Services2014
IMaryland Head Start2015
JMaryland Health Connection Connector Entities2014
KMaryland Local WIC Agencies2014
LMaryland VFC Contact Center2015
MMedicaid Administration & Billing Contacts2015
NMedicaid HealthChoice Managed Care Organization Resource List2015
OMedicaid HealthChoice Managed Care Organization Pharmacy Benefit Managers2014
PMedicaid Transportation Grant Program Local Transportation Managers2014
QMSDE Local Child Find Programs2015
RMSDE Local Infants & Toddlers Programs2016
SREM Contact Information2016
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