EPSDT
CA | NE | TX
"6. The CHDP form, Confidential Screening/Billing Report, PM 160, will be used for reporting all CHDP encounters." California Contract, page 20.
"(d) The PCP/Contractor
shall take a proactive approach to ensure clients obtain HEALTH CHECK (EPSDT)
screening services and medically necessary diagnosis and treatment services.
A proactive approach may include: ...
(5) Referrals
to public health agencies for environmental assessments and care giver
education services for children with lead poisoning." Nebraska Contract,
pages 76- 77.
"B.3.2.3.4 Texas Health Steps
Monitoring
a. The care of children
is a critical public health concern. The Medicaid program has recognized
the importance of early intervention by creating the EPSDT program (known
in Texas as Texas Health Steps). This program covers health check-ups which
are age appropriate and provides for Medicaid services which might not
otherwise be considered covered services. Immunizations and medically necessary
follow-up care are included as part of the Texas Health Steps Program.
Both the State and the Federal government set performance goals. As part
of an ongoing QI program, the Contractor must monitor the effort put forth
by PCPs in reaching out to children when the PCP is notified of the children's
need for screening. The Contractor can aid in the effort to ensure that
children are seen in accordance with the periodicity schedule by including
Texas Health Steps information on each PCP's quarterly profile. The Contractor
can propose other steps it will take to enhance the number of check ups
and immunizations accomplished.
b. The Contractor must review a PCP's Texas Health Steps record during all site visits and through a.-review of claims data. With the State Agency. the Contractor must establish a protocol for corrective action depending on the percentage of check ups and immunizations achieved for the enrolled patient population. A report of findings and corrective actions must be submitted to the State Agency quarterly..." Texas RFP, pages 29-31.
