• 2019-2020 Kids Quality Agenda Performance Improvement Project

  • Affinity Health Plan will participate in New York State’s Medicaid Managed Care Kids Quality Agenda Performance Improvement Project (Kids PIP) from 2019-2020. The Kids PIP is part of the governor’s First 1,000 Days on Medicaid initiative, and aims to improve outcomes and access to services for children in the first three years of life. Running from the second half of 2019 through the end of 2020 (with extension if the program shows success), the Kids PIP will focus on three early childhood screenings: blood lead testing and follow-up, newborn hearing loss and follow-up, and developmental screening.

    Lead Testing

    The standards for testing and follow-up for lead have changed. Affinity urges providers to adhere to the latest CDC recommendations, which are more stringent than the current (soon to be updated) DOH standards. Most important, the CDC now uses a blood lead reference value of five (5) micrograms per deciliter to identify children with higher than most children’s blood lead levels. It is recommended that those children receive follow-up venous blood testing within three months.

    What providers should know

    • Providers will receive monthly reports based on the new recommendations alerting them of the members who have not had a capillary or venous blood test between nine months and 18 months of age, as well as members between 18 and 36 months of age who have not been tested/retested.
    • Affinity’s clinical quality team will work with providers to address their lead testing rates and to develop action plans for improvement.
    • The spring 2019 member newsletter described the dangers of lead and the importance of lead testing. As a follow-up, the fall 2019 edition will encourage members to have their children tested for lead as well as for the other hearing and developmental screenings outlined in the Kids PIP.

    Newborn Hearing

    The NY Department of Health website has information on early hearing detection and intervention (EHDI) for both parents and providers. The main site is https://www.health.ny.gov/community/infants_children/early_intervention/newborn_hearing_screening/.  There are significant resources for providers on how to use the NYEHDI-IS, including a user manual and help-desk contact information.

    What providers should know

    • Providers will receive quarterly reports alerting them of patients who are one month of age and have yet to receive a hearing screening.
    • The report will also include patients who are three months of age and have not passed a newborn hearing screening and have not received a diagnostic audiological evaluation.
    • Providers who are working with Affinity’s clinical quality team will receive additional assistance for addressing low performing screening barriers.
    • The provider toolkit contains information about coding inconsistency and requirements for hearing screening and follow-up, including codes to ensure accurate reporting. Visit

    https://www.affinityplan.org/Providers/Providers/.

    • In September 2019, Affinity’s Quality Management Department delivered a webinar on submission of supplemental data to Affinity Health Plan. Contact QM@AffinityPlan.org for a copy of the slides and for information on how to submit data.

    Developmental Screening

    Children with CHIP/Medicaid are significantly less likely to receive early intervention for autism. The earlier a child is diagnosed; the greater their chances for improvement and the sooner parents receive needed support.

    What providers should know

    • Affinity will track timely global developmental screening using the CPT code 96110. The CG modifier “policy applied” will be used to track autism-specific screening.
    • When a child has a positive result on an autism screen, the provider can make simultaneous referrals to a developmental physician for further evaluation and to the early intervention program in the child’s home county.
    • Affinity will create twice-annual reports for providers alerting them of any patients who are one, two, or three years old and have not received a developmental screening. These reports will be available on the provider portal.