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Medicaid Optimizing Children’s Health 0-36 Months and Development to Improve Long-Term Outcomes
11/18/2019 • Posted by Provider Relations

In January 2019, Fidelis Care initiated the Medicaid KIDS Performance Improvement Project (PIP): Optimizing Children’s Health and Development to Improve Long-Term Outcomes. The aim of this PIP is to improve children’s health by increasing lead, hearing, and developmental screenings with appropriate follow-up by the time the child reaches 3 years of age. The project will run through December 2020.

We have posted an educational tip sheet Important Guidelines for Infants and Toddlers that lists the guidelines as per the New York State Department of Health (SDOH), American Academy of Pediatrics, and the Centers for Disease Control and Prevention on:

  • Immunization schedules
  • Lead testing, follow-up, and retesting
  • Primary care visits
  • Hearing examination and follow-up
  • Developmental screening and contact information for early intervention programs

The SDOH has posted revised documentation on “Guidelines for the Health Care Providers for the Prevention, Identification and Management of Lead Exposure in Children” and additional resource materials.  Please reference the resource links below:

https://www.health.ny.gov/environmental/lead/docs/commissioner_letter_guidance_aug2019.pdf
https://www.health.ny.gov/publications/6671.pdf
https://www.health.ny.gov/publications/2526.pdf
www.health.ny.gov/publications/2524.pdf
https://www.health.ny.gov/publications/6670.pdf

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Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

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