Steps States Can Take to Ensure Children and Adolescents Receive Vision and Hearing Services

The goal of the Medicaid benefit for children and adolescents is to make sure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting. State Medicaid agencies can take the following simple, concrete steps to ensure that enrolled children and adolescents receive any needed services after a positive vision or hearing screen:

1. Establish and promote periodicity schedules for vision and hearing screening that provide for screening at least as often as AAP recommends.
   
   State Highlight: Rhode Island has adopted a periodicity schedule that includes vision and hearing screening that is clear, easy to follow, and matches the AAP’s recommendations. The state mailed copies of the schedule to all providers who serve children and worked with managed care organizations to incorporate the schedule into their member materials.
2. Provide guidelines for Medicaid providers on the content of age-appropriate vision and hearing screenings and when to make a referral for diagnosis and treatment if necessary.
   
   State Highlight: The Illinois provider handbook includes detailed information about the purpose of subjective and objective vision screenings, which screening tools providers should use to conduct an eye evaluation and to test for visual acuity, and when to refer a child for further evaluation. It also indicates that primary care providers should follow the AAP hearing screening recommendations and includes objective hearing screening procedures and referral criteria for children four years old and older. For providers in other settings, the handbook includes information about the risk factors highly associated with delayed-onset hearing impairment in infants and instructs providers where to refer infants and young children for further evaluation and treatment.
   
   State Highlight: The Kansas provider handbook indicates which age-appropriate procedures providers should use when performing a vision screening. In line with the AAP’s recommendations, the manual instructs providers to use multiple screening tools during each vision screening.
3. States should consider developing a fact sheet for providers that explains the importance of vision screening and the state’s guidelines. When developing a fact sheet, states can partner with their state chapter of the AAP and AAFP.
4. Inform Medicaid beneficiaries of the importance of detecting and treating vision and hearing problems and the services available through Medicaid for children and adolescents. States must also explain that Medicaid will provide assistance with transportation and scheduling appointments upon request.
5. Recognize vision and hearing screenings as distinct screenings with separate billing codes and costs. Separate codes enable states to document that these screens are occurring.
   
   State Highlight: The District of Columbia provides enhanced payment for vision and hearing screenings and has introduced a modifier code for screenings that require follow-up or referral.
6. Expand sites that perform vision and hearing screening. Depending on the laws in the state, school sites may be Medicaid enrolled providers, part of a Medicaid managed care network, or work in partnership with Medicaid-participating providers. Schools are a logical place to find children and screen children. Information sharing will be necessary to help coordinate care and avoid duplication of effort and claiming.
   
   State Highlight: New Mexico has developed a School-Based Health Center/Managed Care Organization (SBHC/MCO) project. Through the project, SBHCs provide a range of services, including EPSDT screening services, to school-age children. Across the state, 52 SBHCs are able to bill Medicaid. The project has established guidelines to help SBHCs, primary care providers, and managed care plans communicate and coordinate care.
   
   States considering expanding vision and hearing screenings to school sites should consult recent CMS guidance regarding Medicaid Payment for Services Provided Without Charge (Free Care).
7. Strengthen managed care contracts - Ensure that managed care contracts specify in their care coordination requirements all plan responsibilities related to screening results that require follow-up care or referral.  Also, add provisions to contracts that specifically address vision and hearing screening and care, including professional specialists in vision and hearing such as ophthalmologists, optometrists, and audiologists.
8. Enlist managed care organizations’ help to track providers’ rates of vision and hearing screening for Medicaid enrolled children in their practices.
   • Track the number of children who receive recommended vision and hearing screenings.
     
     State Highlight: After completing a well-child visit, providers in Hawaii submit a standardized form indicating which screening services the child received. With data gathered from these forms, the state or plans can determine if children enrolled in Medicaid are receiving appropriate vision and hearing screening services, and take appropriate steps to address any problems identified.
   • Monitor in real time if individual children receive EPSDT vision screenings. For example, electronic health records designed for pediatric use can track screening, diagnostic, and treatment services received. This can assist the plan and providers in conducting follow up as well as in undertaking improvement efforts
   • Adopt written policies to provide incentives or require corrective action related to vision and hearing screening performance targets.
9. Incorporate vision and hearing screening services into external quality review activities. Several organizations, including the National Center for Children’s Vision and Eye Health and the Institute for Clinical Systems Improvement have developed quality measures related to screening children for vision problems. The National Quality Forum has endorsed quality measures related to newborn hearing screening, review of the screening results, diagnostic evaluation, and referral for early intervention services. CMS has added the diagnostic evaluation measure to the Child Core Set. States are encouraged to report the measure to CMS in their annual Child Core Set reporting.
   • Support contracted health plans to develop Performance Improvement Projects aimed at increasing the number of children who receive recommended vision and hearing screening services.

References

CMS, 

 (2003)

Wendy L. Marsh-Tootle et al., Vision and Eye Health in Children 36 to <72 Months: Proposed Data Definitions, 92 OPTOMETRY AND VISION SCI. 17 (2015)