Reimbursable Diagnostic Services:
- Comprehensive History and Physical Examination, including neurologic assessment, usually performed at approximately 4 to 8 months, 12 to16 months, and 18 to 36 months (adjusted for chronological age). Earlier or more frequent visits (in addition to the three Standard Visits) may be determined to be medically necessary by the HRIF Program. Examinations may be completed by one of the following: a CCS Program–approved (also known as CCS Program-paneled) physician (pediatrician or neonatologist), or a pediatric nurse practitioner (PNP). A PNP functioning in this role does not require CCS Program-approval and is practicing under the direction of a physician.
- Developmental Assessment performed at each of the three Standard Visits (4 to 8 months, 12 to 16 months, and 18 to 36 months). At the 3rd and final Standard Visit (18 to 36 months), a developmental test such as the Bayley Scales of Infant Development (BSID) 3rd edition must be performed. Earlier or more frequent assessments (in addition to the three Standard Visits) may be determined to be necessary by the HRIF Program. Each assessment during the child’s three-year eligibility period may be performed by one of the following who has training in the evaluation of motor and sensory development of high-risk infants: a CCS Program-approved pediatrician or neonatologist, PNP, CCS Program-approved nurse specialist (registered nurse with a Bachelor’s of Science Degree in Nursing), CCS-approved physical therapist, CCS Program-approved occupational therapist, or CCS Program-approved psychologist. The PNP functioning in this role does not need to be CCS Program-approved.
- Family Psychosocial and Needs Assessment iperformed during each of the child’s Standard Visits by a CCS Program approved social worker, PNP or CCS Program approved nurse specialist with expertise in family psychosocial assessment. Referral shall be made to a social worker upon identification of significant social issues by a PNP or nurse specialist. Additional assessments may be determined to be necessary by the social worker, PNP, or nurse specialist.
Hearing Assessment, for infants:
- Under six months of age who were not screened in the hospital: A referral shall be made to a Newborn Hearing Screening Program (NHSP)-certified Outpatient Infant Hearing Screening Provider for an automated Auditory Brainstem Response (ABR) hearing screen. A list of NHSP-certified screening providers is available on the NHSP website: http://www.dhcs.ca.gov/services/nhsp or by calling the NHSP toll-free number at 1-877-388-5301; or
- Over six months of age who were not screened in the hospital: A referral shall be made to a CCS Program-approved Type C Communication Disorder Center (CDC) for a diagnostic audiology evaluation; or
- Who did not pass the inpatient NICU hearing screen: A referral shall be made to a NHSP-certified Outpatient Infant Hearing Screening Provider for an automated ABR rescreen if under six months of age or to a Type C CDC for a diagnostic audiology evaluation if over six months of age; or
- Who do not have a hearing loss (passed initial screen, passed rescreen, passed diagnostic evaluation) but has one or more risk factors for developing a progressive or late-onset hearing loss, (as per the most recent version of the Joint Committee on Infant Hearing Position Statement [www.jcih.org]): A referral shall be made to a Type C CDC for at least one diagnostic audiology evaluation by 24 to 30 months of age. Earlier or more frequent assessments may be indicated for infants and children at high risk.
- Ophthalmologic Assessment, performed by a CCS Program-approved ophthalmologist with experience and expertise in the retinal examination of the preterm infant. The assessments are to be done in accordance with the American Academy of Pediatrics Policy Statement “Screening Examination of Premature Infants for Retinopathy of Prematurity” Pediatrics, Vol. 131: Number 1, January 2013, P.189-195 and until the ophthalmologist determines the child is no longer at risk for developing retinopathy of prematurity.
- Home Assessment for the purpose of evaluating the family for specific needs in the home environment (i.e. to determine if there are appropriate resources to assure access to services; evaluate the parent/infant interaction; and parent’s understanding of infant care, development, and special needs). The home assessment, when planned, shall be provided by a home health agency (HHA) nurse, preferably experienced in evaluating the maternal/infant environment, and is not to be utilized to perform direct services. Medical justification must be provided by the HRIF Program physician if additional home assessments are required beyond the first year’s initial two allowable visits.