EPSDT Part 1 - azahcccs.gov · Federal Statute 42 CFR 440.345 • Pursuant to federal Medicaid law...

Back To Basics EPSDT Part 1

1/8/19

What Does an EPSDT Visit Look Like?

Bright Futures and AHCCCS Tracking Forms

2 Reaching across Arizona to provide comprehensive quality health care for those in need

Current EPSDT Enrollment

Select Quality Measures

Federal Statute 42 CFR 440.345 • Pursuant to federal Medicaid law 42 USC 1396a(a)(10), federal and

state regulations, AHCCCS policy, and contract, Title XIX Contractors must cover EPSDT services for persons under the age of 21, including screening, vision, dental, and hearing services as well as any other services listed in the Medicaid Act (regardless of whether or not in the Arizona State Plan) when “necessary to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.” EPSDT services are defined in 42 USC 1396d(r). For individuals under the age of 21, EPSDT requires that Contractors cover treatments and procedures within any of the categories of Medicaid-covered services listed in 42 USC 1396d(a) if that treatment or service is necessary to “correct or ameliorate” defects or physical and mental illnesses or conditions.

Medicaid.gov

• https://www.medicaid.gov/medicaid/benefits/epsdt/index.html

• AHCCCS State Plan (Medicaid/CHiP) https://www.azahcccs.gov/Resources/StatePlans/

CMSHHSgov Series (10:58)

• https://www.youtube.com/watch?v=O3cYN7z3q0M

• Modules for training staff

Raising Healthy Arizona Kids (5:26)

• https://vimeo.com/2740145

• Parental guidance

Bright Futures

• Periodicity Schedule: https://www.aap.org/en-us/professional-resources/practice-transformation/managing-patients/Pages/Periodicity-Schedule.aspx

• AHCCCS aligns except for 30 month EPSDT visit

• New addenda: (SDoH; ACE; PP depression)

9 Reaching across Arizona to provide comprehensive

quality health care for those in need

AHCCCS Periodicity Schedule

The 6 X 15 Measure

EPSDT - Newborn

Well Child Visits – Infant (5:00)

• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwia86aivKzfAhWlIjQIHdAmBp4QtwIwAHoECAkQAQ&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DyedMu9C70m4&usg=AOvVaw2527q2JmWcDaHgDG4vWH7f

• Harvard Vanguard Series

CDC Recommendations: Legend

Birth to 15 months

EPSDT – 1 Month

EPSDT – 2 Months

EPSDT – 4 Months

EPSDT – 6 Months

EPSDT – 9 Months

EPSDT – 12 Months

EPSDT – 12 Month (3:32)

• https://www.youtube.com/watch?v=90w3FtNQFT8

• Focus on anticipatory guidance

EPSDT – 15 Months

EPSDT – Signs of Autism (6:37)

• https://www.youtube.com/watch?v=z7NeBs5wNOA

• Emphasis on early detection beginning at the 12 month EPSDT visit

18 Months to 18 Years

EPSDT – 18 Months

Well Child Visit – 18 months (10:22)

• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=2ahUKEwia86aivKzfAhWlIjQIHdAmBp4QtwIwAXoECAgQAQ&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DKfY635WtgJY&usg=AOvVaw0MjzJFBBnpc44fj_sG7r7q

EPSDT – 24 Months

30 Month EPSDT

• See Bright Futures

• NOT a separately covered AHCCCS service

Well Child 3 Years to 6 Years Participation

EPSDT – 3 years

EPSDT – 4 Years

EPSDT – 4 Years (6:21)

• https://www.youtube.com/watch?v=lbHHlbaEYMI

• Can you spot some problems?

o Visual Acuity

o Hearing

EPSDT – 5 years

EPSDT – 6 Years

Well Child Visit – 7 Years (3:26)

• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=2ahUKEwia86aivKzfAhWlIjQIHdAmBp4QtwIwA3oECAUQAQ&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DfDbrZlz6O7s&usg=AOvVaw29F8WMtX1RS60ryAgO5mjW

EPSDT – 7 to 8 Years

Adolescent Measure

HHS.gov TAG Talks

• https://www.hhs.gov/ash/oah/tag/resources/multimedia/index.html

• Drug use

• Bullying

• Transition to adulthood

• Guidelines for Adolescent Preventative Services

• Organize, restructure and redefine health care for children and adolescents ages 11 – 21

• Allows identification of at-risk patients and provide them with information about changing unhealthy behavior.

GAPS Recommendations

Example of the Tool

Guidance

• Reassurance that information remains confidential

• Appropriate use of screening tests (i.e., sexually active adolescents)

• Use of mnemonics

• Delegate some responsibility to ancillary health care providers

Mnemonics

Sick Visit / EPSDT Visit

• AMPM 430 D 1 – 4

• Allowed with separate documentation

Updating the Process

• See proposed revisions for AMPM 430

• EHR equivalents to AHCCCS paper tracking forms

• Obtaining tracking data from other sources

• Exploring interface with HIE

Questions?

Thank You.

EPSDT Part 1 - azahcccs.gov · Federal Statute 42 CFR 440.345 • Pursuant to federal Medicaid law...

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