Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM
Subchapter 6 - EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT)
Section 17-1737-57 - Screening

(1) Comprehensive health and developmental history, including assessment of both physical and mental health development;

(2) Comprehensive unclothed physical examination;

(3) Appropriate immunizations according to age and health history;

(4) Appropriate vision testing;

(5) Appropriate hearing testing;

(6) Appropriate laboratory tests, including lead blood level assessment appropriate for age and risk factors;

(7) Routine dental examination furnished by direct referral to a dentist which includes bitewing x-ray, scaling and polishing, and topical application of fluoride as deemed necessary in accordance with section 17-1737-75; and

(8) Health education including anticipatory guidance.

(1) Age twelve to twenty-four months - complete the clinical oral exam and appropriate diagnostic tests to assess oral growth and development and/or pathology; provide oral hygiene counseling for parents, guardians and caregivers; remove supra-and subgingival stains or deposits as indicated; assess the child's systemic fluoride status and provide fluoride supplementation if indicated, following drinking water analysis; assess appropriateness of feeding practices; provide dietary counseling relating to oral health; provide injury prevention counseling for orofacial trauma (play objects, pacifiers, car seats, etc.); provide counseling for oral habits (digit, pacifiers, etc.); provide diagnosis and required treatment for any oral disease or injuries; provide anticipatory guidance for parent/guardian; assess topical fluoride status and give parental counseling; provide injury prevention counseling for orofacial trauma (learning to walk, run, etc.);

(2) Age two to six years - repeat twelve to twenty-four month procedures every six months or as indicated by individual patient's needs/susceptibility to disease; provide age-appropriate oral hygiene instructions; complete a radiographic assessment of pathology and/or abnormal growth and development, as indicated for individual patient's needs; scale and clean the teeth every six months or as indicated by the individual patient's needs; provide topical fluoride treatments every six months or as indicated by the individual patient's needs; provide pit and fissure sealants for permanent teeth as indicated by the individual patient's needs; provide counseling and services (athletic mouth guards) as needed for orofacial trauma prevention; provide assessment/treatment or referral of developing malocclusion as indicated by individual patient's needs; treat any oral disease/habits/injuries as indicated;

(3) Age six to twelve years - repeat two to six year procedures every six months or as indicated by individual patient's needs/susceptibility to disease; provide injury prevention counseling/services for orofacial trauma (sports activities); provide substance abuse counseling (smoking, smoke less tobacco, etc.); and

(4) Age twelve to twenty years - repeat six to twelve year procedure every six months or as indicated by individual patient's needs/susceptibility to disease.