Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Provision of care and services.
The periodicity schedule contained in this section and
the contents of the C/THP examination generally follow those recommended by the
Committee on Standards of Child Health of the American Academy of Pediatrics.
Appropriate modifications in the content of the examination can be made
according to the attending physician's medical judgment, consistent with the
needs of the individual child and current recommended standards of medical
practice.
(b)
Contents of an examination.
Every C/THP examination should include the following as
appropriate by age:
(1) Comprehensive
health history.
(i)
(a) For a new patient, a complete family
history, social history, past medical history, and review of body systems must
be obtained and recorded.
(b) When
obtaining the comprehensive health history of children five years of age or
younger, the history must include details of pregnancy, delivery, birth weight
and the neonatal period.
(c) When
obtaining the comprehensive health history of adolescents, a review of the body
systems should also include a history of sexual activity and use of
contraception and a menstrual history for females.
(d) For patients whose initial histories have
already been recorded by the C/THP provider, the family, social and medical
histories may be confined to the period since the histories were last
recorded.
(ii) The
histories may be obtained initially by health assistants, provided the C/THP
provider reviews and supplements the histories at the time the provider
conducts his or her examination of the child.
(2) Comprehensive physical examination.
The examination of a person eligible for C/THP services
must be performed by a licensed physician or by a physician's assistant or
registered professional nurse qualified to provide primary care services under
a physician's supervision, and is to consist of a systematic examination of all
parts of the body, including appropriate neurological, dental, otoscopic and
funduscopic examinations and observation of the back for scoliosis. Results of
the physical examination must be recorded in the medical record by body
regions. Blood pressure measurements must be taken for all children three years
of age and older.
(3)
Assessment of physical growth and nutritional status.
Height and weight for all persons eligible for C/THP
services, as well as head circumference for infants, are to be measured and
recorded at each examination. Measurements of height and weight through the
fifth year of age, and of head circumference through one year of age and again
at two years of age, should be plotted on a standard growth chart, which is to
be incorporated into the medical record. Plotting of measurements for older
children and adolescents is recommended but not required.
(4) Assessment of mental and psychosocial
development.
(i) For children through five
years of age, a detailed developmental history of the infant or child must be
obtained and documented in the child's medical record. The history should
include information relating to speech, cognitive, emotional, psychosocial and
gross and fine motor development. Administration of a standardized (formal)
developmental screening test, such as the Denver Developmental Screening Test
(DDST) or the abbreviated DDST, is recommended but not required. The child's
health status must also be updated at each periodic visit in such a way as to
allow for serial evaluation.
(ii)
For children 6 to 12 years of age, an assessment of the psychosocial adjustment
should include a discussion of school performance and peer and family
relationships.
(iii) For
adolescents 13 years of age and older, an assessment of the psychosocial
adjustment should include a discussion of peer and family relationships,
school/job performance, use of drugs, alcohol or tobacco and sexual
preparedness and activity.
(5) Vision testing.
(i) For children less than three years of
age, testing should include the following elements:
(a) Observation of the infant's/child's
reaction to an object of interest such as a light or familiar toy for gross
indication of vision. Each eye is required to be observed separately.
(b) Motility screening, including gross
inspection of the eye to determine the presence of any obvious strabismus, and
the cover test, which is especially valuable in patients with a small deviation
from the norm.
(ii) For
children three years of age and older, testing for visual acuity is to be
performed and repeated at each examination and must include a distant visual
acuity test, which can be performed using the Snellen letter or Symbol E chart.
The use of alternative tests (HOTV or Matching Symbol, Faye Symbol, Allen
Pictures) should be considered for those preschoolers who cannot be tested by
the Snellen letter or Symbol E chart.
(iii) If a child wears eyeglasses, an
assessment regarding the need for optometric reevaluation should be made based
on screening the child with eyeglasses and the length of time since the last
optometric evaluation.
(6) Hearing testing.
(i) For children less than three years of
age, infant hearing should be tested grossly by the use of loud noises.
Deafness must be seriously suspected if there is a delay in development in
speech in the older infant.
(ii)
For children three years of age and older, testing which consists of a manually
administered, individual, pure-tone conduction screening procedure should be
provided at each examination.
(iii)
In all instances when hearing impairment is suspected by the medical provider
based upon testing or an evaluation of the child's risk of hearing impairment,
a prompt referral to an approved speech and hearing center must be
made.
(7) Assessment of
immunization status and provision of immunizations.
(i) An assessment of the record of
immunizations given in the past for diphtheria, pertussis, tetanus, polio,
rubella, measles and mumps must be recorded. If the dates of the child's
previous immunizations are available, they should be recorded in the child's
medical chart. If the immunization history is based on parents' reports,
efforts to verify this information must be made. Such efforts must be
recorded.
(ii) Persons eligible for
C/THP services should be immunized in accordance with the following schedules:
(a) Schedule for children beginning
immunization in infancy.
|
Age |
Vaccines |
Comments |
| 2 months |
DTP |
DTP = diphtheria, tetanus, pertussis, |
| TOPV |
TOPV = trivalent oral polio vaccine. |
| 4 months |
DTP, TOPV |
| 6 months |
DTP |
An optional dose of TOPV may be given. |
| 15 months |
Measles Mumps Rubella |
One dose of combined measles/mumps/rubella (MMR)
vaccine is preferred; a tuberculin skin test may be administered at the same
visit. |
| 18 months |
DTP TOPV Hib |
Hib = Haemophilus influenzae type b disease
immunization of children at 18 months may be considered in known high-risk
groups. |
| 24 months |
Hib |
Hib immunization of all children is recommended at
this age. |
| 4-6 years (school entry) |
DTP TOPV |
While often referred to as "boosters" these doses
constitute an essential part of the immunization process. |
| 14-16 years |
Td |
Td = Tetanus and diphtheria for adults; repeat
every 10 years. |
(b) Schedules for children not immunized as
infants.
(1) Age 13 months through 6 years.
| Visit | Vaccines | Comments |
| DTP TOPV | MMR may be substituted; see
comment for visit 2. |
| One-month interval between visits. |
| 2 | Measles Mumps Rubella | MMR should
be given at first visit when risk of exposure is high; DTP and TOPV may then be
started at second visit and interval between visits 2 and 3 extended to two
months. |
| One-month interval between visits. |
| 3 | DTP, TOPV |
| Two-month interval between visits. |
| 4 | DTP | An optional dose of TOPV may
also be given. |
| 6- to 12-month interval between
visits. |
| DTP TOPV | Interval between visits 4 and 5
may be extended(e.g., school entry), but not shortened. |
| 10-year interval between visits. |
| 6 | Td | Repeat every 10 years. |
The Hib vaccine can be provided any time from 24 months
up to five years of age.
(2) Ages 7 years through 20 years.
| Visit | Vaccines | Comments |
| 1 | Measles Mumps
Rubella* | One dose of Td and one dose of TOPV
may also be given at this visit if circumstances warrant (see simultaneus
administration of vaccines). |
| One-month interval between visits. |
| 2 | Td
TOPV** | This visit may be eliminated if first
doses of Td and TOPV are given at visit 1. |
| Two-month interval between visits. |
| 3 | Td
TOPV** | If visit 2 is eliminated, the
interval between visits 1 and 3 must be at least two months. |
| 6- to 12-month interval between
visits. |
| 4 | Td
TOPV** | Interval between doses 3 and 4 may be
extended but not shortened. |
| 10-year interval between visits. |
| 5 | Td | Repeat every 10 years. |
*Before rubella vaccine is
administered to females past menarche, the patient and/or her parent/guardian
must be asked if she is pregnant. Pregnant patients must not be given rubella
vaccine. If the patient is not pregnant, the theoretical risks to a fetus and
the importance of not becoming pregnant for three months following vaccination
must be explained to the patient before the vaccine is administered.
**TOPV should not be routinely
administered to persons 18 years of age and older.
(3) Simultaneous administration of vaccines.
The simultaneous administration of TOPV and one of the following has been shown
to be both safe and effective: MMR, MR, measles, rubella, mumps, DTP, Td. It is
also possible to administer TOPV, MMR (or a product containing one or more of
its component antigens), and either DTP or Td simultaneously (using different
injection sites). This latter practice is warranted if there is doubt that the
recipient will return for further doses of vaccine or if an older, seriously
under-immunized child must be brought up-to-date quickly
(e.g., at the time of school entry). The Hib vaccine can be
provided any time between the ages of 24 months and six years.
(4) Interruption of immunization schedule.
When a delay between doses does not interfere with final immunity and does not
necessitate starting the series over again, regardless of the interval elapsed,
the schedule may simply be resumed where it was left off.
(8) Laboratory and
other diagnostic tests.
If a particular test (e.g.,lead
screening) is not indicated for a specific age group (or any age group), but
the child presents history or symptoms calling for the test's use, the test
should be performed.
(i) Tuberculin
screening. The assessment for tuberculin risk should be made at each visit,
with skin tests performed at age 12-13 months, three years and at each age
interval thereafter. A tuberculin test should be administered prior to
immunizing a child against measles. If that is not possible, the tuberculin
test should be administered simultaneously with the measles vaccine. A
tuberculin test should be delayed at least six weeks after the administration
of a measles vaccine. Where the child's histories indicate a higher risk of
tuberculosis, the test should be administered more frequently.
(ii) If the phenylketonuria (PKU) test was
not performed at birth, because, for example, the baby was born out-of-state,
the PKU test should be performed at the first C/THP exam (within one
month).
(iii) Sickle cell
screening. Those who are at risk of sickle cell disease must receive sickle
cell screening. If the clinician makes the judgment that the child is not at
risk (by ethnicity or previous screening), a statement of the assessment should
appear in the child's medical record. Children born in hospitals within New
York State after 1975 are assumed to be adequately screened for sickle cell
disease. If the child is at risk of sickle cell disease and there is any doubt
about previous testing, sickle cell screening should be provided as part of the
exam.
(iv) Anemia screening. A test
for anemia must be done at age 9-10 months, 23-25 months, 3 years, 4 years, 5
years, 6 years, and repeated routinely at each age interval as set forth in
subdivision (f) of this section. High-risk infants under nine months should
also be tested. Where the child's histories indicate a higher risk, the test
should be administered more frequently.
(v) Lead screening. Lead screening must be
performed routinely on all children aged nine months through five years and at
other times judged appropriate by the provider. Education for the prevention of
lead poisoning should be directed toward the parent at the time the child is
first screened and at subsequent visits.
(vi) Venereal disease screening. Adolescents
aged 13 years and older must be assessed for the need for serological screening
for syphilis, and all sexually active females should be offered a routine
gynecological examination, pap smear, gonococcal culture and counseling
regarding the prevention of unplanned pregnancies. If the provider is not
properly equipped to perform these services, referral to a gynecologist, family
planning or obstetrical/gynecological clinic is recommended.
(9) Urine screening.
A urinalysis must be performed at age three years and
repeated at each age interval set forth in subdivision (f) of this
section.
(10) Dental care
assessment.
All children up to age three should have their mouths
examined at each medical evaluation and, where appropriate, should be referred
for dental care. All children aged three years and over should be referred to a
dentist or a dental program for diagnostic evaluation and necessary treatment,
unless the child has been to a dentist in compliance with the C/THP examination
schedule as set forth in subdivision (f) of this section.
(11) Diagnosis and treatment follow-up.
A summary diagnosis and plan for treatment or referral
and follow-up must be recorded in each child's medical record. Diagnostic and
treatment services must be given at the time of the C/THP examination, if
appropriate. If a finding requires more extensive diagnosis and/or treatment
than is immediately available, an appointment for these services must be
scheduled within 60 days of the C/THP examination. The referring physician or
clinic is responsible for follow-up, and results of the diagnostic evaluation
should be documented in the medical records.
(12) Observation for child abuse and neglect.
Suspected cases of child abuse and maltreatment must be
reported to the New York State Central Register of Child Abuse and Maltreatment
pursuant to the provisions of section 413 of the Social Services Law.
(c)
Continuity of
care.
The C/THP provider should be available not only for
initial and periodic C/THP examinations, but also for illness-related
services.
(d)
Consultation.
Consultation with other medical providers should be
obtained when deemed necessary by the C/THP provider.
(e)
Referral for further diagnosis
and/or treatment.
When a C/THP examination reveals abnormal conditions and
follow-up care is deemed necessary by the C/THP provider, such care must be
provided or arranged. Referral to appropriate providers must be made for
services which the C/THP provider does not provide. Identification of a
condition requiring further diagnosis or treatment during a C/THP examination
must be indicated by completion of the CHAP referral code on the claim form
submitted for payment.
(f)
The following periodicity schedule will apply to all C/THP examinations:
(1) 0-1 year-within 1 month; 2-3 months; 4-5
months; 6-7 months; 9-10 months.
(2) 1-6 years-12-13 months; 14-15 months;
16-19 months; 23-24 months; 3 years; 4 years; 5 years.
(3) 6-21 years-6 years; 8-9 years; 10-11
years; 12-13 years; 14-15 years; 16-17 years; 18-19 years; 20 years.
(g)
Nonscheduled
examination.
When a C/THP examination is requested for a child at an
age which does not appear on the periodicity schedule contained in subdivision
(f) of this section, the provider should, at a minimum, perform those
components of the C/THP examination which are required by the last periodic
examination the child should have received.
(h)
Incomplete required
examination.
Submission of a claim for a C/THP examination assumes
that the provider has taken responsibility to assure that the examination was
complete. If the provider cannot complete a recommended component of the
examination at the time of the initial examination, every effort should be made
to complete the examination at a date determined to be appropriate by the
provider.
