Iowa Admin. Code r. 441-78.18

Current through Register Vol. 47, No. 11, December 11, 2024

Rule 441-78.18 - Screening centers

Payment will be approved for health screening as defined in 441-subrule 84.1(1) for Medicaid members under 21 years of age.

(1) In order to be paid for the administration of a vaccine covered under the Vaccines for Children (VFC) program, a screening center must enroll in the VFC program. Payment for the vaccine will be approved only if the VFC program stock has been depleted.

(2) Payment will be approved for necessary laboratory service related to an element of screening when performed by the screening center and billed as a separate item.

(3) Periodicity schedules for health, hearing, vision, and dental screenings.

a. Payment will be approved for health, vision, and hearing screenings as follows:

(1) Six screenings in the first year of life.

(2) Four screenings between the ages of 1 and 2.

(3) One screening a year at ages 3, 4, 5, and 6.

(4) One screening a year at ages 8, 10, 12, 14, 16, 18, and 20.

b. Payment for dental screenings will be approved in conjunction with the health screenings up to age 12 months. Screenings will be approved at ages 12 months and 24 months and thereafter at six-month intervals up to age 21.

c. Interperiodic screenings will be approved as medically necessary.

(4) When it is established by the periodicity schedule in 78.18(3) that an individual is in need of screening the individual will receive a notice that screening is due.

(5) When an individual is screened, a member of the screening center shall complete a medical history. The medical history shall become part of the individual's medical record.

(6) Rescinded lAB 12/3/08, effective 2/1/09.

(7) Payment will be made for persons aged 20 and under for nutritional counseling provided by a licensed dietitian employed by or under contract with a screening center for a nutritional problem or condition of a degree of severity that nutritional counseling beyond that normally expected as part of the standard medical management is warranted. For persons eligible for the WIC program, a WIC referral is required. Medical necessity for nutritional counseling services exceeding those available through WIC shall be documented.

(8) Payment shall be made for dental services provided by a dental hygienist employed by or under contract with a screening center

This rule is intended to implement Iowa Code section 249A.4.

Iowa Admin. Code r. 441-78.18

ARC 0065C, lAB 4/4/12, effective 6/1/12