Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) Program

1. Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) Program Presenter's Name, Title, Date, and Location

2. One of the most valuable tools we have to ensure West Virginia children stay healthy is the HealthCheck model.

3. What is HealthCheck? Pediatric preventive health program for Medicaid eligible children and youth up to 21 years of age. West Virginia’s federally mandated EPSDT Program.

4. What is EPSDT? Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) is a federally mandated comprehensive health care benefit package for Medicaid enrolled individuals under the age of 21. The primary emphasis of EPSDT is preventive care.

5. EPSDTAcronym The first three letters of EPSDT refer to the fact that eligible children are entitled to regular comprehensive assessments of their health, or Early Periodic Screening. The last two letters of EPSDT are triggered by the health screenings. Once a child is seen by his or her provider and a screen reveals a problem, a Diagnosisis made and medically necessary Treatmentcan be provided.

6. EPSDT Process

7. Bright Futures Bright Futures is a set of principles, strategies, and tools that are theory based, evidence driven, and systemsorientedthat can be used to improve the health and well-being of all children.

8. Medical Home Both an approach to providing comprehensive primary care and a health care setting that facilitates partnerships between individual patients and their personal physicians.

9. Periodicity Periodicityrefers to the screening intervals recommended by theAmerican Academy of Pediatrics.

10. HealthCheck Screening Services

11. Health and Medical History A comprehensive Health and Medical History should be completed during the child’s initial screen. The initial Health and Medical History information should be reviewed and updated at each periodic screen.

12. Growth Measurements Height and Weight should be plotted on a growth chart at the initial and each periodic screen. Head Circumference should be plotted on a growth chart from birth to 2 years of age. Body Mass Index (BMI) should be calculated and plotted on a BMI chart at the initial and each periodic screen beginning at age 2 through 21years of age.

13. Blood Pressure Blood Pressure should be obtained at 3years and each periodic screen thereafter.

14. Tuberculosis (TB) Risk Screen A Tuberculosis Risk Screen should be completed at the following ages:1month, 6months, and every year beginning at 12months up to 21 years. If a child is identified as high risk, further TB screening protocol as set forth by the WV TB Program should be initiated.

15. Lead Risk Screen A Lead Risk Screen should be completed at the initial and each periodic screen beginning at 6months through 6 years of age. A Serum Lead Test should be completed at 12 and 24 months and up to 72 months if the child has never been screened.

16. Dyslipidemia Risk Screen A Dyslipidemia Risk Screen should be completed at the following ages: 2 years, 4 years, 6 years,8years, 10 years and every year beginning at 11 years up to 21 years. A Fasting Lipid Profile should be obtained when one or more risk factors indicate high risk.

17. Developmental Surveillance Developmental Surveillance is a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care. Developmental Surveillance should be completed at the initial and each periodic screen.

18. Developmental Screen A Developmental Screen, via a standardized screening tool, should be completed at the following ages: 9months, 18 months and 30 months. Additional developmental screening, via administration of a standardized screening tool, may be conducted anytime caregiver or primary care provider concerns are identified.

19. Autism Screen Autism Surveillance should be completed at the initial and each periodic screen. An Autism Specific Screen should be completed at 18 and 24 months or at any other time a concern arises.

20. Psychosocial/Behavioral A Psychosocial/Behavioral Assessment should be completed at the initial and each periodic screen from0years up to 21years of age. An Alcohol and Drug Use Assessment should be completed at the initial and each periodic screen beginning at 11years of age.

21. Vision Screen A Vision Screen should be completed at the initial and each periodic screen. An Objective Vision Screen should be completed at the following ages: 3, 4, 5, 6, 8, 10, 12, 15,and 18years. A Subjective Vision Screen should be completed at the initial and each periodic screen when an objective screening is not completed.

22. Hearing Screen A Hearing Screen should be completed at the initial and each periodic screen. An Objective Screen should be completed at the following ages: birth, 4, 5, 6, 8 and 10 years. A Subjective Hearing Screen should be completed at the initial and each periodic screen when an objective screening is not performed.

23. Oral Health Screen An Oral Health Screen should be completed at the initial and each periodic screen to determine the presence of any current dental problems, date of last dental visit, and availability of fluoride in the water. Every child should either be under the care of a dentist or referred to a dentist by 12 months of age.

24. Physical Examination An unclothed comprehensive Physical Exam should be completed at the initial and each periodic screen from birth up to 21years of age.

25. Health Education Health Education, including age appropriate anticipatory guidance, is to be provided at the initial and each periodic screen from birth up to 21 years of age.

26. Immunization Screen Immunizationrecords should be reviewed at the initial and each periodic screen. Vaccines should be administered when appropriate.

27. Laboratory Tests Every child should have a Newborn Metabolic Screeningcompleted. A Hemoglobin/Hematocritshould be completed at the 12 month screen. A Fasting Lipoproteinshould be completed at 20 years of age.

28. Laboratory - Lead A Blood Lead Level should be completed at 12months of age, 24months of age & 36 months to 72 months if child has never been screened. A referral should be made if blood lead level is = or > 10 to the WV Childhood Lead Poisoning Prevention Program.

29. Referrals & Documentation When a screen indicates the need for further evaluation, a referral should be made to the appropriate provider. For children who require a service beyond the benefit package limitations, the primary care provider must have documented the medical necessity for the service during the provision of EPSDT screening services.

30. WV Kids First All children entering school for the first time in the state of WV should have a well child screen following the HealthCheckprotocol outlined on each age appropriate screening form.

31. HealthCheck Provider Manual The Provider Manual is available on the HealthCheckwebsite. A CD or paper manual is available upon request. www.dhhr.wv.gov/healthcheck

32. Preventive Health Screen Forms The Preventive Health Screening Forms are available on the HealthCheck website. Providers have the option of using their own screening forms or electronic medical records.

33. Program Specialists The HealthCheck Program Specialists focus on equipping Medicaid providers with the necessary tools and knowledge to carry out EPSDT screening services that meet reasonable standards of medical practice.

34. Billing ALL billing questions: www.wvdhhr.org/bms Molina 1-888-483-0793

35. Thank You Questions?