1. (a) Eligibility. Medi-Cal beneficiaries who have received an initial health assessment are also eligible for subsequent, periodic health assessments.
2. (b) Notifying and Offering Assistance. Persons eligible for periodic assessments shall be notified before each assessment is due of their entitlement to the assessment, and of the availability of assistance with transportation and scheduling appointments. The informing may be in writing. The response to this offer shall be recorded, and this assistance shall be provided if requested by the beneficiary.

3. (c) Frequency. Persons eligible for periodic health assessments shall receive one assessment during each age period listed below. The first age at which the next health assessment is due is the age of the person at the previous assessment plus the interval indicated in the parenthesis after that age period in the table shown in this subsection. However, a periodic assessment may be done at any time from the beginning to the end of each age period. Persons will be considered overdue for an assessment on the first day he or she enters a new age period without assessment having been performed in the previous age period.

   For example, a child receiving an assessment at two and one-half years of age is first due for the next assessment at three and one-half years of age (the age at the time of previous assessment, two and one-half plus the time interval between assessments for that age group, one year). The assessment is overdue when the child is four years old. There is no time interval in the 17-20 age period because no additional assessments will be given after that assessment. Initial and periodic assessments, and the initiation of any needed treatment, shall normally be completed within 120 days from either the last day the person is eligible for assessment in any age period or the day the person is notified that the next assessment is due, whichever occurs first.

   The following table is a guide for the minimum frequency at which health assessments shall be provided to persons eligible for periodic assessments:

   Under 1 month old

   (1 month)

   1 through 2 months old

   (2 months)

   3 through 4 months old

   (2 months)

   5 through 6 months old

   (2 months)

   7 through 9 months old

   (3 months)

   10 through 12 months old

   (3 months)

   13 through 17 months old

   (5 months)

   18 through 23 months old

   (6 months)

   2 years old

   (1 year)

   3 years old

   (1 year)

   4 through 5 years old

   (2 years)

   6 through 8 years old

   (3 years)

   9 through 12 years old

   (4 years)

   13 through 16 years old

   (4 years)

   17 through 20 years old

4. (d) Additional Health Assessments. The frequency indicated in this section is considered a minimum for preventive health care. More frequent health assessments will be reimbursed when the additional assessment is deemed appropriate by the health assessment provider. Circumstances which may indicate the need for more frequent assessments include the following:

   1. (1) The parents have or the person has a particular need for education and guidance.
   2. (2) There is the presence or possibility of perinatal disorders (such as low birth weight, low Apgar scores at birth, prolonged labor).
   3. (3) The person is or will be exposed to a potentially stressful environment--for example, camp or contact sports--before the next periodic health assessment indicated by the periodicity schedule is due.
5. (e) Limitations. Reimbursement at more frequent intervals will not be made for a health assessment of an individual for the purpose of monitoring or treating a specific disease or disorder previously diagnosed, or for a person whose overall health status requires ongoing treatment care. Such individuals are still eligible for regular assessments if they are otherwise eligible for CHDP services.

Note: Authority cited: Sections 208, 321 and 323.7, Health and Safety Code. Reference: Sections 320 and 323.7, Health and Safety Code.

History

1. New section filed 11-28-79 as an emergency; effective upon filing (Register 79, No. 48). A Certificate of Compliance must be filed within 120 days or emergency language will be repealed on 3-28-80.

2. Certificate of Compliance filed 3-27-80 (Register 80, No. 13).

3. Amendment of subsections (c) and (d)(2) filed 5-22-80; effective thirtieth day thereafter (Register 80, No. 21).