Proposition 56 Developmental Screenings
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Effective for dates of service from January 1, 2020, through December 31, 2021, Medi-Cal reimburses providers a supplemental incentive payment of $59.90 for developmental screenings with funds from the California Healthcare Research and Prevention Tobacco Tax Act of 2016 (Proposition 56). A developmental screening is the use of a standardized set of questions to see if a child's motor, language, cognitive, social, and emotional development are on track for their age.
National guidelines recommend developmental screening performed at well-child visits for all children at 9 months, 18 months, and 30 months of age, and when medically necessary when risk is identified on developmental surveillance. All children enrolled in Medicaid are entitled to receive developmental screenings as it is a required service for children under the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
Providers must use a standardized screening tool that meets the criteria set forth by the American Academy of Pediatrics (AAP) and the Centers for Medicare & Medicaid Services (CMS). Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the child’s family and/or caregiver and any clinically appropriate actions were documented. This documentation should remain in the beneficiary’s medical record and be available upon request.