Communications: News

Child and Teen Checkups - Guideline Updates

Tuesday, August 8, 2017   (0 Comments)
Posted by: Tara Owens
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Delay in Implementation of Some Screening Components for Child & Teen Checkups

Based upon information shared by providers, DHS is allowing additional time for full implementation of some of the screening components or health services shown on the October 2017 version of the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule). until March 1, 2018.

  • Weight for length percentile for infants up to two years of age
  • Social determinants of health as part of the health history
  • Human immunodeficiency virus (HIV) screening at least once between ages 15 and 18 years (regardless of reported sexual activity or risk factors)
  • Dyslipidemia risk assessment
  • The addition of the near visual acuity (plus lens) screening beginning at age 5 years for children who pass their distance screening and do not already have corrective lenses
  • The addition of high frequency hearing screening at age 11 years (6,000 Hz at 20 dB)

If you submitted claims for preventive health screening visits provided on dates of service of October 1, 2017, or later, but did not enter the two-letter HIPAA - compliant referral code because you had not implemented one or more of the new requirements, you may replace these claims if you provided the rest of the required screening components. Resubmit these claims indicating a complete C&TC visit by adding the appropriate two-letter referral code.

If you have already implemented all of the October 2017 C&TC Schedule of Age-Related Screening Standards, please continue to follow those standards between now and March 1, 2018. Continue to work toward implementation if you have not yet implemented the March 1, 2018, requirements.

Review the Child and Teen Checkups section of the MHCP Provider Manual for more details of the requirements. Review both page 1 and page 2 of the C&TC Periodicity Schedule for additional details and clarification of the October 1, 2017, revisions and the C&TC FACT Sheets for each component. (pub. 1/5/17)

Resources for Mental Health Screening

The following mental health screening resources have been updated for Child and Teen Checkups (C&TC), as of January 2018, including updates on using the PHQ-2 screening instrument as a first-step option.

•    List of all recommended Developmental and Mental Health Screening Instruments for C&TC Visits (all ages) in Minnesota - 2018 (PDF)
•    Mental Health Screening (6-20 years) C&TC Fact Sheet: Updated links within this fact sheet include:

The list of recommended Mental Health Screening Instruments for Children 6-21 Years of Age and the detailed comparison table for more information on each instrument.

PHQ-2 Instrument Review: In summary,The PHQ-2 is acceptable as a first-line screener to meet the C&TC requirement for depression or mental health screening for youth 12-20 years of age. While it is preferable to use a more robust screening instrument such as the PHQ-9, particularly in clinics and systems that have not yet developed rigorous screening practices, or where prevalence of depression is low, the PHQ-2 has been validated in numerous studies, showing high sensitivity and sufficient specificity at a cutoff score ≥ 2. Scores at or beyond this cutoff should be further screened with the PHQ-9 or another validated screening measure, at the same screening visit.

The Minnesota Child & Teen Checkups (C&TC) periodicity schedule requirements are updated as of October 1, 2017.

The C&TC schedule changes are based on the updated 2017 version of Bright Futures from the American Academy of Pediatrics, along with changes in US Preventive Services Task Force pediatric recommendations, MN Community Measurement guidelines, and the most recent Minnesota-specific health data for the C&TC-eligible population.

Many clinics are already doing some of these screening changes as a result of health system/clinic priorities. Key changes include:

  • Adding C&TC visits at age 30 months, and annual visits for children and youth between the ages of 6 to 20 years;
  • Requiring fluoride varnish application at every C&TC visit beginning at the eruption of first tooth through age 5 years;
  • Requiring standardized depression or mental health screening annually from ages 12 through 20 years;
  • Requiring a screening HIV test for all youth at least one time between ages 15 through 18 years and risk assessment for HIV testing followed by appropriate action for youth ages 11-14 years and 19-20 year olds (this risk assessment is a part of the previously required sexually transmitted infection (STI) risk assessment);
  • Adding near vision screening (plus lens) beginning at 5 years to the standard visual acuity screening (which starts at 3 years) for children who pass their distance visual acuity screening and do not have corrective lenses;
  • Adding high frequency screening (6000 Hz) for noise-induced hearing loss at 11 years and older to the standard hearing screening (which starts at 3-4 years);
  • Clarifying dyslipidemia risk assessment followed by appropriate action for ages 24 months, 4 years, 6 years and for ages 8 through 20 years;
  • Including social determinants of health in the health history;
  • Continued emphasis on social-emotional, developmental and autism screening recommended for all infants and toddlers.

Additionally, staff from Minnesota Department of Health and Minnesota Department of Human Services are preparing updated clinical guidance C&TC Fact Sheets for primary care providers, and new parent fact resources for implementing these changes.

For DHS communications regarding the Minnesota Child and Teen Checkups (C&TC) schedule of Age-Related Screening Standards and related policy, refer to the Provider News on the DHS website. Providers can also sign up to receive the Provider News by email. 

Current C&TC Periodicity Schedule (DHS-3379)

Updated policy C&TC Section of the MHCP Provider Manual

Resources for implementation of the updated C&TC Periodicity Schedule are now available on the MDH C&TC Website

  • Fact Sheets for Each Screening Component
  • Information for Providers - Including clinic resources for family and youth (HIV FAQ and parent confidentiality template, under "Laboratory Tests/Risk Assessment)
  • Recorded webinar reviewing all updates available on the C & TC Training Website.

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