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School Health: EPSDT. Virginia Department of Medical Assistance Services (DMAS) October 2-3, 2007. Training Goals. Overview of EPSDT EPSDT Screening content Specific Screening Guidelines Lead Testing and Vaccines For Children Diagnosis and Treatment EPSDT Specialized Services

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school health epsdt

School Health:EPSDT

Virginia Department of Medical Assistance Services (DMAS)

October 2-3, 2007

training goals
Training Goals
  • Overview of EPSDT
  • EPSDT Screening content
  • Specific Screening Guidelines
  • Lead Testing and Vaccines For Children
  • Diagnosis and Treatment
  • EPSDT Specialized Services
  • Referral Process

DMAS - Providing High Quality Comprehensive Health Services

what are epsdt services
What are EPSDT Services?

EPSDT services include:

  • Screening/Well Child check-ups, lead testing and immunizations
  • Other treatment services to correct a medical condition, make it better, or prevent the child’s health status from worsening

DMAS - Providing High Quality Comprehensive Health Services

eligibility for epsdt screenings
Eligibility for 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.

DMAS - Providing High Quality Comprehensive Health Services

eligibility for epsdt screenings6
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.

DMAS - Providing High Quality Comprehensive Health Services

screening definition
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.

DMAS - Providing High Quality Comprehensive Health Services

screening content
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 AAP compatible “Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents”

DMAS - Providing High Quality Comprehensive Health Services

epsdt screeners
EPSDT Screeners
  • School Health Clinics who employ:
    • Physician
    • Certified Nurse Practitioner
    • Physicians Assistant

DMAS - Providing High Quality Comprehensive Health Services

types of screenings
Types of Screenings
  • AAP recommended screenings:
    • These are typical “well child care”
    • They are conducted according to the DMAS periodicity schedule

DMAS - Providing High Quality Comprehensive Health Services

types of screenings12
Types of Screenings
  • Inter-periodic or partial screenings:
    • These are intermittent physician encounters or “sick visits”
    • Problem-focused screening

DMAS - Providing High Quality Comprehensive Health Services

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

Screening Schedule

DMAS - Providing High Quality Comprehensive Health Services

mandated screening elements
Mandated Screening Elements
  • A comprehensive health and developmental history (including assessment of both physical and mental health development);
  • A comprehensive unclothed physical exam;

DMAS - Providing High Quality Comprehensive Health Services

mandated screening elements15
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;

DMAS - Providing High Quality Comprehensive Health Services

mandated screening elements16
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

DMAS - Providing High Quality Comprehensive Health Services

mandated screening elements17
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.

DMAS - Providing High Quality Comprehensive Health Services

screening and treatment
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

DMAS - Providing High Quality Comprehensive Health Services

epsdt scope of services
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

DMAS - Providing High Quality Comprehensive Health Services

slide20

Thank You!

EPSDT Coordinator

Brian Campbell

804-786-0342

[email protected]

DMAS - Providing High Quality Comprehensive Health Services

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