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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
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Select Quality Measures
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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.
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Medicaid.gov
• https://www.medicaid.gov/medicaid/benefits/epsdt/index.html
• AHCCCS State Plan (Medicaid/CHiP) https://www.azahcccs.gov/Resources/StatePlans/
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CMSHHSgov Series (10:58)
• https://www.youtube.com/watch?v=O3cYN7z3q0M
• Modules for training staff
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Raising Healthy Arizona Kids (5:26)
• https://vimeo.com/2740145
• Parental guidance
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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
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AHCCCS Periodicity Schedule
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The 6 X 15 Measure
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EPSDT - Newborn
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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
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quality health care for those in need
CDC Recommendations: Legend
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Birth to 15 months
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EPSDT – 1 Month
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EPSDT – 2 Months
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EPSDT – 4 Months
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EPSDT – 6 Months
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EPSDT – 9 Months
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EPSDT – 12 Months
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EPSDT – 12 Month (3:32)
• https://www.youtube.com/watch?v=90w3FtNQFT8
• Focus on anticipatory guidance
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EPSDT – 15 Months
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EPSDT – Signs of Autism (6:37)
• https://www.youtube.com/watch?v=z7NeBs5wNOA
• Emphasis on early detection beginning at the 12 month EPSDT visit
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18 Months to 18 Years
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EPSDT – 18 Months
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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
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EPSDT – 24 Months
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30 Month EPSDT
• See Bright Futures
• NOT a separately covered AHCCCS service
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Well Child 3 Years to 6 Years Participation
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EPSDT – 3 years
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EPSDT – 4 Years
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EPSDT – 4 Years (6:21)
• https://www.youtube.com/watch?v=lbHHlbaEYMI
• Can you spot some problems?
o BP
o Visual Acuity
o Hearing
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EPSDT – 5 years
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EPSDT – 6 Years
36 Reaching across Arizona to provide comprehensive quality health care for those in need
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
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quality health care for those in need
EPSDT – 7 to 8 Years
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EPSDT – 9 to 12 Years
39 Reaching across Arizona to provide comprehensive quality health care for those in need
Adolescent Measure
40 Reaching across Arizona to provide comprehensive quality health care for those in need
HHS.gov TAG Talks
• https://www.hhs.gov/ash/oah/tag/resources/multimedia/index.html
• Drug use
• Bullying
• Transition to adulthood
41 Reaching across Arizona to provide comprehensive quality health care for those in need
EPSDT – 13 to 17 Years
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GAPS
• 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.
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GAPS Recommendations
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Example of the Tool
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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
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Mnemonics
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Sick Visit / EPSDT Visit
• AMPM 430 D 1 – 4
• Allowed with separate documentation
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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
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Questions?
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Thank You.
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