We have adopted the CMS definition and components of the CHCUP/EPSDT exam and the American Academy of Pediatrics periodicity schedule for CHCUP visits. The CHCUP/EPSDT benefit, in accordance with Section 1905(r) of the Act, must include the following services:

1. Screening Services – Screening services must include all of the following services:

• Comprehensive health and developmental history – both physical and mental health assessment;
• Comprehensive unclothed physical exam;
• Appropriate immunizations – see Advisory Committee on Immunization Practices (ACIP) pediatric vaccines schedule;
• Laboratory tests – as outlined in AAP Recommendations for Preventive Pediatric Health Lead Toxicity Screening – All Medicaid children are considered at risk for lead poisoning. CMS requires that all Medicaid children receive a screening blood lead test at 12 months and 24 months of age. Children between the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been previously screened for lead poisoning
• Health Education – includes anticipatory guidance to assist parents (guardians) and/or children 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;
• Vision Screening – Vision should be assessed at each well child visit. In infants, the history and subjective findings of the ability to regard and reach for objects, the ability to demonstrate an appropriate social smile, and to have age appropriate interaction with the examiner is sufficient. At ages four and above, objective measurement using the age-appropriate Snellen Chart, Goodlite Test, or Titmus Test, should be done and recorded. If needed, a referral should be made to an ophthalmologist or optometrist.
• Dental Screening – A general assessment of the dental condition (teeth and/or gums) should be obtained on all children at each well child visit. As indicated and beginning at age 2 years old a referral should be made to a dentist.
• Hearing Screening – A hearing test is required appropriate to the child’s age and educational level. For the child over age four, an audiometer, if available is recommended. If needed an appropriate referral should be made to a specialist.
• Other Necessary Health Care – Provide other necessary health care, diagnosis services, treatment, and other measures described in Section 1905(a) of the Act to correct or ameliorate defects, and physical and mental illnesses and conditions discovered by the screening services.

2. Diagnosis - When a screening examination indicates the need for further evaluation of an individual’s health, provide diagnostic services. The referral should be made without delay and follow-up to make sure that the recipient receives a complete diagnostic evaluation. If the recipient is receiving care from a continuing care provider, diagnosis may be part of the screening and examination process.

3. Treatment – Health care must be made available for treatment or other measures to correct or ameliorate defects and physical and mental illnesses or conditions discovered by the screening services.

4. Periodicity Schedule - Sunshine Practitioners are required to provide CHCUP services in accordance with the most current AAP Recommendations for Preventive Pediatric Health Care.