New EPSDT Guidance
The Centers for Medicare & Medicaid Services (CMS) recently released new guidance, Best Practices for Adhering to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Requirements, regarding coverage requirements for eligible children and youth who are enrolled in Medicaid and CHIP.
The guidance discusses policies, strategies, and best practices to maximize health and opens a critical window of opportunity to enhance EPSDT. It details state requirements and outlines strategies to promote awareness, improve access, expand the workforce, and highlight other areas of importance.
The guidance is divided into three broad topics:
- Promoting EPSDT awareness and accessibility to ensure eligible beneficiaries have comprehensive coverage, are aware of their coverage, know how to access Medicaid benefits, and have supports like transportation and care coordination to facilitate getting the care that they need.
- Expanding and using the child-focused (EPSDT) workforce by broadening provider qualifications, using telehealth, encouraging the use of interprofessional consultation, and using payment methodologies to address provider shortages and to help assure that there are an adequate number of health care providers available to meet the needs of beneficiaries.
- Improving care for EPSDT-eligible children with specialized needs, with a particular focus on how EPSDT requirements relate to the unique needs of children with behavioral health conditions, children in foster care, and children with disabilities or other complex health needs.
Background on EPSDT
The EPSDT benefit provides comprehensive and preventive health care services for eligible children, with the primary goal of providing “the right care, to the right child, at the right time, in the right setting.”
Comprehensive well-child visits, referred to in statute as screening services, are the foundation of EPSDT coverage. Well-child visits are an early opportunity to promote lifelong health and well-being, and to identify concerns and conditions that require follow-up care. States are required to develop or adopt a schedule of recommended screenings; most states adopted the Bright Futures periodicity schedule developed by the American Academy of Pediatrics (AAP) or a modified version.
