DOH Developmental and Behavioral Screening EPSDT Early and Periodic Screening, Diagnosis, and Treatment in Medicaid Insurance
Early and Periodic Screening, Diagnostic, and Treatment
https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html
Developmental and Behavioral Screening
Periodic developmental and behavioral screening during early childhood is essential to identify possible delays in growth and development when steps to address deficits can be most effective. These screenings are required for children enrolled in Medicaid and are also covered for children enrolled in CHIP. This CMS Fact Sheet describes CMS resources to support states in ensuring enrolled children receive these screenings. Birth to 5: Watch Me Thrive!, a joint effort between the Department of Health and Human Services and the Department of Education, provides additional resources to support states, providers, and communities to increase developmental and behavioral screening of young children.
State Program Guidelines
State Medicaid agencies are required to:
Inform all Medicaid-eligible individuals under age 21 that EPSDT services are available and of the need for age-appropriate immunizations;
Provide or arrange for the provision of screening services for all children;
Arrange (directly or through referral) for corrective treatment as determined by child health screenings; and
Report EPSDT performance information annually via Form CMS-416.
The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit provides comprehensive and preventive healthcare services for children under age 21 who are enrolled in Medicaid.
EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.
Early: Assessing and identifying problems early
Periodic: Checking children's health at periodic, age-appropriate intervals
Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and
Treatment: Control, correct or reduce health problems found.
EPSDT Services
States are required to provide comprehensive services and furnish all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines. EPSDT is made up of the following screening, diagnostic, and treatment services:
Screening Services
Comprehensive health and developmental history
Comprehensive unclothed physical exam
Appropriate immunizations (according to the Advisory Committee on Immunization Practices)
Laboratory tests (including lead toxicity screening
Health Education (anticipatory guidance including child development, healthy lifestyles, and accident and disease prevention)
Vision Services
At a minimum, diagnosis and treatment for defects in vision, including eyeglasses. Vision services must be provided according to a distinct periodicity schedule developed by the state and at other intervals as medically necessary. For additional information visit the Vision and Hearing Screening Services for Children & Adolescents page.
Dental Services
At a minimum, dental services include relief of pain and infections, restoration of teeth, and maintenance of dental health. Dental services may not be limited to emergency services.
At a minimum, hearing services include diagnosis and treatment for defects in hearing, including hearing aids. For additional information visit the Vision and Hearing Screening Services for Children & Adolescents page.
Other Necessary Health Care Services
States are required to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.
Diagnostic Services
When a screening examination indicates the need for further evaluation of an individual's health, diagnostic services must be provided.
Treatment
Necessary health care services must be made available for the treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.