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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

23-442m Help Ensure Children Receive Regular Well-Child Visits in First 15 Months of Life

Date: 05/25/23

Patients enrolled in First Year of Life Program can access resources 

Well-child visits are important during the early months of a child’s life. These visits can help assess growth, development, and identify and address problems early. This measure is based on the Centers for Medicare & Medicaid Services (CMS) and American Academy of Pediatrics (AAP) guidelines that call for at least six well-child visits from birth to 15 months of age. Early intervention increases overall wellness and reduces medical costs. Well-child visits provide an opportunity for providers to influence health and development. These annual visits are a critical opportunity for screening and counseling.

California Health & Wellness Plan’s (CHWP) First Year of Life Program is available to children from birth through the first 15 months of life. The program provides members information on the importance of well-child visits, immunizations, developmental milestones, and general support.

Whether this is their first child or they already have children at home, extra support is always helpful. The First Year of Life Program can help:

  • Improve health outcomes for newborns.
  • Increase your Healthcare Effectiveness Data and Information Set (HEDIS®) rates for well-child visits and immunizations.
  • Reduce hospitalizations and inappropriate emergency room visits.
  • Provide parent/caregiver support.

Overview of program

The First Year of Life Program provides parents and caregivers with education, support and service coordination. Here are some of the program highlights that members can benefit from. The program:

  • Is managed by a clinical team with background and experience in pediatrics and post-partum care.
  • Includes phone outreach that aligns with the Centers for Disease Control and Prevention (CDC) well-child check schedule and occurs at 2, 4, 6, 9, 12 and 15 month intervals.
  • Supports and connects members with appropriate pediatric specialists.
  • Conducts age-appropriate assessments to identify and refer members to appropriate level of service and resources.
  • Provides education on the importance of vaccinations, adherence to the well-child visits, the nurse advice line, urgent care centers, and provider extended hours.

Eligibility and enrollment

The program is open to all eligible members; however, our plan is to prioritize members with social disparities and inequities. Member eligibility criteria are as follows:

  • Infants between ages of 0 to 15 months
  • Infants without Complex Pediatric Case Management needs

To enroll in the First Year of Life Program:

  • Members can contact the Plan’s Member Services Department at the toll-free number printed on the back of the member’s ID card.
  • Providers may submit a Case Management Referral form. Be sure to include the words “First Year of Life Program” written on the form.

 Additional information

Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877 658 0305.          

 

This information applies to Physicians, Independent Practice Associations (IPAs), Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers and OBGYNs.