The vendor is required to provide early periodic screening, diagnostic and treatment (EPSDT) liaison services and support to primary care practices for increasing immunization rates, as well as a behavioral health educational program for pediatric primary care providers.
- Primary care physicians in dialogue with agency on issues related to coding, billing, and documentation of EPSDT services and assisting in the development of related informational resources for primary care providers by:
• Serving as a resource for information on the most current national coding practices and national trends, including advising agency on national trends in uses and payment of individual codes such as the trend to begin reimbursing separately for hearing, vision, and other current procedural terminology codes for services provided in conjunction with EPSDT visits;
• Developing and maintaining forms for documentation of EPSDT exams and convening a committee (comprised of representatives of agency, each managed care organization (MCO), the department of health, and the prospective supplier) as needed to review updates to said forms;
• Developing and producing pediatric and EPSDT and coding resources and training materials;
• Maintaining forms in an electronic version on the prospective supplier’s website;
• Participating with agency, MCOs, and other professional health organizations in EPSDT outreach efforts and other collaborative efforts, including collaborating with the managed care organization (MCOs) on outreach to high yield practices and concentrating on regional training programs as appropriate; and
• Developing and maintaining a well child quality improvement (qi) project to help practices increase and improve the number of EPSDT services provided.
• The qi project offers maintenance of certification part iv as well as continuing medical education.
• Staff supports practices in implementing quality improvement through training and consultation
- The program includes the development and implementation of training programs for pediatricians and other primary care providers to increase the frequency, quality, and documentation of EPSDT services by:
• Making available provider education from various sources including regional training programs;
• Maintaining a training module, which includes;
o EPSDT overview;
o A review of individual screening components and what is included in each component (comprehensive health history, including developmental and behavioral screening, physician exam, immunization, laboratory work, hearing and vision screening and anticipatory guidance);
o Coding and billing; and
o Documentation (including electronic access to prospective supplier EPSDT forms)
• Marketing training programs to the target audience.
• Training with respect to coding is not be limited to coding for EPSDT and includes;
o Development of one EPSDT related webinar or another special project
o Providing consultations for primary care providers with electronic health records related to EPSDT and coding compliance, and
o Approaching physicians new to state and newly credentialed providers recommended to prospective supplier by participating MCOs.
• Providing visits to individual offices, providing regional educational programs, and providing education through professional newsletters, and
• Providing outreach to approximately ten (10) physicians' offices/new physicians per month to include office visits, office-based trainings, regional "lunch and learns", conducting mock chart audits, outreach by email or telephone, and/or MCO activities, participating in physician outreach events (such as exhibiting at conferences or presenting at meetings of primary care-related professional organizations or conducting regional EPSDT coding trainings.)
- The overarching goal of the BeHiP program is to raise the confidence and competency of pediatricians and other providers who work with children with behavioral and mental health concerns.
• Maintaining a training curriculum that provides pediatric healthcare providers with tools and strategies to screen for, assess, and manage patients with emotional, behavioral and substance use concerns
• Updating training curriculum to include discussion of evidence-based treatments for substance use disorders in adolescents, including medications for opioid use disorder and adolescent and family-specific therapies.
• Participants will be empowered to connect adolescents to high quality, evidence-based treatment, and actively support their long-term recovery.
• Including in its training curriculum strategies to provide for more efficient workflow (including information on coding), more effective care, and improved family and physician relationships.
• Offering associated BeHiP online training modules covering specific topics such as attention deficit hyperactivity disorder, depression, anxiety, substance use disorders and more to help pediatric healthcare providers become more familiar with the resources and screening tools available.
- The program includes an optional BeHiP quality improvement project to practices with associated qi coaching to help practices implement and increase the use of various screening tools which includes:
• Designing and managing the qi project;
- Staffing for the BeHiP program includes:
• Retaining project medical director(s) as needed as well as content experts for ongoing updates to and delivery of the program curriculum.
• Retaining and training additional pediatricians as program trainers to deliver the curriculum.
- The program also includes promoting the availability of the behavioral health in pediatrics BeHiP training to providers serving children through various outreach efforts such as:
• Direct marketing to practices;
• Communication with residency programs;
• Sharing information in chapter newsletters and at conference exhibits;
• Sharing information in the chapter’s training and other work with the consult services;
• During monthly virtual extension for community healthcare outcomes (ECHO) sessions for support and the foster care medical home program;
• Other opportunities as they arise; and
• Maintain information about the program and associated resources on the prospective supplier web site.
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