adhere to a periodicity schedule, and identify a strategy for facilitating the use of age-appropriate, validated screening tools.
Screening and Preventive Services
- a. Coverage of Behavioral Health Related Screenings and Preventive Services
Screening[1] and preventive services improve overall health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions. This makes routine screening, early identification, and treatment of behavioral health conditions particularly important for children and pregnant women. Several organizations make evidence-based recommendations for screening and preventive services for populations in a primary care setting. The American Academy of Pediatrics (AAP) publishes the Bright Futures periodicity schedule, referred to as “Recommendation for Preventive Pediatric Health Care.”[2] AAP/Bright Futures provides a schedule of screenings recommended at each well-child visit from infancy through adolescence. The majority of states have already adopted the current version (fourth edition published in March 2019) of the AAP/Bright Futures periodicity schedule for both CHIP and Medicaid children. Some states have maintained a previous version of this schedule, or made modifications to it. The U.S. Preventive Services Task Force (USPSTF)[3] also recommends clinical preventive services for children and adults, including pregnant women.
All states will be required to provide coverage of all of the developmental and behavioral health related screenings, and preventive services recommended by AAP/Bright Futures, as well as those with a grade of an A or B by USPSTF. This new requirement is consistent with the “prevent’ and “diagnose” provisions specified in section 5022 of the SUPPORT Act. The required screenings and services are specified in Table 1 below, and the detailed AAP/Bright Futures periodicity schedule can be viewed at the organization’s website.
In addition, states will be required to specify the periodicity schedule they have adopted for children. If a state elects a periodicity schedule other than the current version of the AAP/Bright Futures periodicity schedule, it will have to ensure that the types of screening and preventive services, and the recommended schedule for delivering these services at well-child visits, are at least comparable to the most up-to-date AAP/Bright Futures standards. In the future, states will need to ensure that they are covering screens and preventive services consistent with the most
recently published AAP schedule. These requirements are consistent with industry standards in the private and public sector, and currently in practice in the majority of states. We recognize
that periodicity schedules serve as a guideline for recommendations in this area, but clinical judgement will continue to be an important element in the provision of these services.
- ↑ Screening is a formal process that employs a standardized tool to detect a particular concern or condition. Universal screening is performed on all individuals at certain ages to identify those at risk of a particular condition. Selective screening is performed for individuals who have already been identified as at risk of having a behavioral health condition.
- ↑ The Health Resource and Services Administration (HRSA) launched the Bright Futures program in 1990 to address a need for unified guidance on how to design the most modern, efficient, and comprehensive pediatric checkup. The Bright Future/AAP periodicity schedule is available at: https://www.aap.org/en-us/Documents/periodicity_schedule.pdf.
- ↑ The Agency for Healthcare Research and Quality supports the USPSTF, an independent panel of experts on prevention and evidence-based medicine, to provide rigorous recommendations on prevention to the federal government and the public. The USPSTF recommendations are available at: https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-brecommendations/#more.
