016.06.36-203.120. Physician's Role in the Child Health Services (EPSDT) Program.
AR ADC 016.06.36-203.120Arkansas Administrative Code
Ark. Admin. Code 016.06.36-203.120
016.06.36-203.120. Physician's Role in the Child Health Services (EPSDT) Program.
The Child Health Services (EPSDT) program is a federally mandated child health component of Medicaid. It is designed to bring comprehensive health care to individuals eligible for medical assistance from birth up to their 21st birthday. The purpose of this program is to detect and treat health problems in the early stages and to provide preventive health care, including necessary immunizations. Child Health Services (EPSDT) combines case management and support services with screening, diagnostic and treatment services delivered on a periodic basis.
A. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a preventive health care program designed for: (1) newborn health evaluations as soon after birth as possible; (2) routine, timely childhood immunizations; (3) regular screenings to detect physical or developmental health problems and (4)treatment and other measures to correct or improve any defects and chronic conditions discovered.
The Arkansas Medicaid Program requires that all eligible EPSDT participants under age 21 receive regularly scheduled examinations and evaluations of their general physical and mental health, growth, development and nutritional status.
Screenings must include, but are not limited to:
Screening services must be provided in accordance with reasonable standards of medical and dental practice, as soon as possible in a child's life and at intervals established by the American Academy of Pediatrics.
An age appropriate screening may be performed when a child is being evaluated or treated for an acute or chronic condition.
The primary care physician may provide the screening or refer the child to a qualified Medicaid provider for screening. Primary care physician referral for ESPDT screening is mandatory in the 75 counties in Arkansas. See Section I of this manual.
Diagnosis is the determination of the nature or cause of physical or mental disease or abnormality through the combined use of health history, physical, developmental and psychological examination, laboratory tests and X-rays.
Treatment means physician, hearing, visual services, or dental services and any other type of medical care and services recognized under State law to prevent or correct disease or abnormalities detected by screening or by diagnostic procedures.
Physicians and other health professionals who provide Child Health Services (EPSDT) screening may diagnose and treat health problems discovered during the screening or may refer the child to other appropriate sources for treatment. If immunization is recommended at the time of screening, immunization(s) should be provided at that time.
When a condition is diagnosed through a Child Health Services (EPSDT) screen and requires treatment services not normally covered under the Arkansas Medicaid Program, those treatment services will be considered for reimbursement if the service is medically necessary and permitted under federal Medicaid regulations. The PCP must request consideration for reimbursement using the EPSDT Prescription/Referral for Medically Necessary Services/Items Not Specifically Included in the Medicaid State Plan Form DMS-693. View or print form DMS-693.
Refer to Section I of this manual (Services Available through the Child Health Services (EPSDT) Program) for additional information.
Physicians interested in becoming a Child Health Services (EPSDT) provider should contact the central Child Health Services Office. View or print Child Health Services Office contact information.
Credits
Eff. Aug. 1, 2007.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.36-203.120, AR ADC 016.06.36-203.120
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