Early and Periodic Screening Diagnosis and Treatment - Special Processing Information

    N-110 
Screening, Diagnosis and Treatment 
(EPSDT) Program is: 

e to actively seek out all eligible 
families and educate them on the 
benefits of preventive and 
continuous health care; 

to help eligibles effectively use 
health resources and encourage 
them to participate in screenings 
at regular intervals; 

to provide for the detection of 
physical and mental problems in 
youth as early as possible through 
comprehensive and continuous 
medical screenings in accordance 
vith program standards; and 

to provide for timely diagnosis 
and appropriate treatment for 
acute or chronic conditions before 
the health problems become more 
complex and their treatment more 
costly. 

EPSDT screening, diagnosis and 
treatment services are available 
statewide to Medicaid eligibles under 
21 years of age. 

  

Issued December 1, 1990 N-100 
EPSDT--General Information  



Chabier 19-B : SRscial —sessLnL 

  

  

. Barly--a Medicaid eligible child 

; should begin to receive high quality 
preventive health care as early as 
possible in life. 

Periodic--occurring at regular 
intervals according to an established 
schedule vhich meets reasonable 
standards of medical, vision, hearing 

and dental practice established after 
consultation with recognized profes- 

sional organizations. 

Screening--an examination using 
simple testing procedures to sort out 

vell children from those who have a 

disease, condition or abnormality 
vhich may need further diagnosis, 

evaluation and/or treatment. Four 

distinct types of screenings are 
required in the EPSDT Program: 

e Medical Screening consists of: 

a comprehensive health and 
developmental history, includ- 
ing assessment of physical and 
mental development and nutri- 
tional status; 

- a comprehensive unclothed 
physical examination/assess- 
ment; 

- immunizations or determination 
-0f immunization status ap- 
propriate for age and health 
history; 

- appropriate laboratory proce- 
dures according to age, risk, 
health history and population 
groups; 

  

Issued December 1, 1990 N-120 
EPSDT--Coverage 

 



  

  

Chabies 19-E 2Recsal BE Stesulng 

- health education, including 
anticipatory guidance and 
interpretive conference; and 

- care coordination. 

e Vision Screening consists of 
history and observation for 
children under age three (if 
testable) or age four and objec- 
tive visual acuity and color 
perception tests after age three 
(1f testable); otherwise, age 
four. 

e Hearing Screening consists of 
history and observation for 
children under age three (if 
testable) or age four and objec- 
tive audiometry testing after age 
three (if testable), otherwise age 
four. 

e Dental Screening consists of oral 
inspection up to age three and 
direct referral to a dentist for 
examination after age three or 
younger, if medically indicated. 

A partial screening consists of one 
or more components of a screening. 

A screening which is provided more 
. frequently or at a different inter- 

vals than the established periodicity 
schedule is called an interperiodic 
screening. 

Since screenings are voluntary 
services, some recipients may decline 
a screening at the appropriate time. 
This does not preclude a child from 
receiving screenings at a later date. 

  

Issued December 1, 1990 2 of N-120 
EPSDT--Coverage 

 



  

Chapter 19-E Special Processing : 
  

. | - Diagnogis--the determination of the 
nature or cause of physical or mental 
disease, condition or abnormality 

- when a medical, vision, hearing, 
dental, or other screening examina- 
tion indicates the need for further 
evaluation of the child’s health 
status. 

TIreatment--Treatment consists of 
health care or other services to 
correct or reduce defects and 
physical and mental illnesses or 
conditions found in the medical, 
vision, hearing and dental screenings 
including: 

e one or more of physician’s or 
dentist’s services, 

¢ optometrist’s services, 

e podiatrist’s services, 

o hospital services (inpatient and 
- outpatient), 

og clinic services, 

e laboratory and X-ray services, 

¢ prescribed drugs, 

e eyeglasses, 

e hearing aids, 

e prostheses, 

e physical therapy, 

e occupational therapy, 

e speech therapy, 

e psychological service, and 

e rehabilitation services. 

  

Issued December 1, 1990 3 of N-120 
EPSDT--Coverage 

 



  

Chiabier 19-E : Jhsclal ys 

  

N-130 PARISH OFFICE 
RESPONSIBILITIES 

Vithin 60 days of the eligibility 
determination, all Medicaid eligible 
recipients under 21 and their 

* families must be informed of and 
offered BPSDT services. 

Inform eligibles that all medically 
necessary services are provided with 
no limitations, subject to BHSF 
approval. 

This includes informing the following 
groups: 

families determined eligible for 
the first time, 

families determined eligible after 
a period of ineligibility, if they 
have not used EPSDT services for 
at least one year, 

families who continue to be 
eligible, but no one who is 
eligible has used EPSDT services 
during the year (the family must 
be informed again of EPSDT annual- 

ly), 

Medicaid eligible pregnant women 
(a Medicaid eligible woman’s 
positive response to an offer of 
EPSDT services during a medically 
verified pregnancy constitutes a 
request for EBPSDT services for the 
child at birth). 

parents of deemed eligible 
newborns, 

parents of newborns at the time 
the infant’s and/or parent’s 
eligibility is determined, and 

Title IV-E foster care children in 

homes and institutions. 

  

Issued December 1, 1990 N-130 
EPSDT--Parish Office Responsibilities 

 



  

Chaplet 19-B ; : Shsasel JiCce saint 

  

Use clear, non-technical language, in 
both the face-to-face interview and 
in writing to explain: 

e the benefits of preventive health 
care, 

oe the services available under the 

EPSDT Program, 

e that BPSDT services are provided 
without cost to them, 

oe where the services are available 

and how to obtain them, 

e that they have freedom of choice 
in selecting screening and other 
health services providers, and 

e that necessary transportation and 
assistance in scheduling transpor- 
tation is available from the 
parish office (a two-day notice is 
required to arrange transportation 
through the local office). 

Use Form BPSDT 8 to inform and offer 
recipients of EPSDT services in 
vriting and to document the offer of 
EPSDT services. Complete and mail 
Form EPSDT 8 at the time of cer- 

‘ tification advising the parent(s) or 
guardian(s) of: : 

e the address and telephone number 
of the available provider selected 
by the family, and 

e how to make an appointment for a 
screening. 

  

Issued December 1, 1990 2 of N-130 
EPSDT--Parish Office Responsibilities 

 



Chapter 19-8 : Special ase sauns 

  

  

A parental consent form must be 
signed during the eligibility 
interviev for each child referred to 
a participating school system for 
screening services. Upon certifica- 
tion, the signed consent form must be 
immediately routed to the appropriate 
BPSDT School Nurse Program. 

N-140 DHH RESPONSIBILITIES DHH is responsible for notifying the 
parish office of participating 
medical, vision, hearing and dental 
providers. 

N-150 QUALIFIED PROVIDER Qualified Providers who determine 
RESPONSIBILITIES presumptive Medicaid eligibility in 

the CHAMP Program are also respon- 
sible for informing pregnant women, 
as well as postpartal women, of the 
availability of EPSDT services. 

N-160 OCS RESPONSIBILITIES On an annual basis, the Office of 
Community Services (OCS) must inform 
foster parents, adoptive parents 
.receiving a subsidy, and administra- 
tors of institutions and group homes 
housing 0CS foster children about 
EPSDT services available for Title 
IV-E foster children. : 

Informing and offering EPSDT services 
J ; must be done on a more frequent basis 

if there is a change in placement. 

  

Issued December 1, 1990 N-140 
EPSDT--DHH Responsibilities