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EPSDT Screening Presentation

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  • 1. School Health: EPSDT Virginia Department of Medical Assistance Services (DMAS) October 6, 2009
  • 2. Eligibility for School Based EPSDT Screenings
    • To be eligible for services provided by a school division, the recipient must be a currently enrolled Medicaid or FAMIS Plus/Medallion recipient under the age of 22 years or a FAMIS enrollee under the age of 19.
  • 3. Eligibility for EPSDT Screenings
    • Students enrolled in a Medicaid managed care organization (MCO) must have EPSDT well-child screenings coordinated through the MCO.
    • School divisions may not bill DMAS directly for EPSDT well-child screenings for MCO enrolled children.
  • 4. EPSDT Screenings
  • 5. Screening Definition
    • EPSDT screenings are Medicaid’s well child visits and should occur according to the DMAS periodicity schedule (attached). Providers must obtain a medical history that is inclusive of mental health risk factors and documents the family’s history of mental health conditions.
  • 6. Screening Content
    • Regardless of the health care delivery system (whether MCO or FFS), the comprehensive health screening/well child visit content should be in line with the most current recommendations of the American Academy of Pediatrics (AAP), Guidelines for Health Supervision
    • Another resource for preventive health guidelines is the “ Bright Futures/AAP: Guidelines for Health Supervision of Infants, Children, and Adolescents”
  • 7. EPSDT Screeners
    • School Health Clinics who employ:
      • Physician
      • Certified Nurse Practitioner
      • Physicians Assistant
  • 8. Types of Screenings
    • AAP recommended screenings:
      • These are typical “well child care”
      • They are conducted according to the DMAS periodicity schedule
  • 9. Types of Screenings
    • Inter-periodic or partial screenings:
      • These are intermittent physician encounters or “sick visits”
      • Problem-focused screening
  • 10. Screening Schedule
    • 1 month
    • 2 months
    • 4 months
    • 6 months
    • 9 months
    • 12 months
    • 15 months
    • 18 months
    • 2 years
    • 3 years
    • 4 years
    • 5 years
    • 6 years
    • 8 years
    • 10 years
    • 12 years
    • 14 years
    • 16 years
    • 18 years
    • 20 years
  • 11. Mandated Screening Elements
    • A comprehensive health and developmental history (including assessment of both physical and mental health development);
    • A comprehensive unclothed physical exam;
  • 12. Mandated Screening Elements
    • Vision screening by a standardized testing method according to the DMAS periodicity schedule;
    • Hearing screening by a standardized testing method according to the DMAS periodicity schedule;
    • Developmental screening with a standard screening tool according to the American Academy of Pediatrics guidelines;
  • 13. Mandated Screening Elements
    • Age appropriate immunizations
    • (if needed)
    • Immunizations are scheduled according to:
    • Advisory Committee on Immunization Practices (ACIP) guidelines:
    • http://www.cdc.gov/nip/recs/child-schedule.htm
  • 14. Mandated Screening Elements
    • Laboratory tests (including lead blood testing at 12 and 24 months or for a new patient with unknown history up to 72 months or as appropriate for age and risk factors);
    • Health Education/Anticipatory Guidance/problem-focused guidance and counseling.
  • 15. Screening and Treatment
    • The results of the examination may indicate a referral for specific medically necessary Medicaid covered services
    • Coordinate Treatment needs with the primary care provider
  • 16. EPSDT Scope of Services
    • Individualized health care, diagnostic services, and “treatment” as listed in the Federal Medicaid statute, must be provided when medically necessary to correct and ameliorate physical and mental conditions discovered during screening services whether or not included in the state plan
  • 17.
    • EPSDT Coordinator
    • Brian Campbell
    • 804-786-0342
    • [email_address]
    Thank You!