016.29.24 Ark. Code R. 007

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.29.24-007 - Vaccine Counseling for Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

215.290Health Education

Health education is a required component of screening services and includes anticipatory guidance. The developmental assessment, comprehensive physical examination, visual, hearing or dental screening provides the initial opportunity for providing health education. Health education and counseling to parents (or guardians) and children are required. Health education and counseling are designed to assist in understanding what to expect in terms of the child's development and to provide information about the benefits of healthy lifestyles and practices, as well as accident and disease prevention. See Section 242.100 for procedure codes.

Health education can include but isn't limited to tobacco cessation counseling services to the parent/legal guardian of the child.

A. Counseling Visits:

View or print the procedure codes and modifiers for Child Health Services/Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services.

* Exempt from PCP referral requirements.

* This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.

B. Referral of patient to an intensive tobacco cessation referral program.

C. Can be billed in addition to an office visit or EPSDT.

D. If the beneficiary is under the age of eighteen (18), and the parent/legal guardian smokes, he or she can be counseled as well, and the visit billed under the minor's beneficiary Medicaid number. The provider cannot prescribe meds for the parent under the child's Medicaid number. A parent/legal guardian session will count towards the four (4) counseling sessions limit described in section C above.

E. These counseling sessions do NOT require a PCP referral.

F. The provider must complete the counseling checklist and place in the patient records for audit. View or print the Arkansas Be Well Referral Form.

Refer to Section 257.000 and Section 292.900 of the Physician's manual for more information.

Health education can include vaccine counseling services to parents and legal guardians, and children. New codes for reimbursement for vaccine counseling under EPSDT are available beginning September 1, 2024. Vaccine counseling is allowed up to four (4) times per year, with the ability to request an extension of benefit limit. View or print DMS contractor information for extension of benefits.

016.29.24 Ark. Code R. 007

Adopted by Arkansas Register Volume 49, Number 09, Effective 9/1/2024