School Health: EPSDT

1. School Health:EPSDT Virginia Department of Medical Assistance Services (DMAS) October 6, 2009

2. Eligibility for School Based EPSDT Screenings • To be eligible for services provided by a school division, the recipient must be a currently enrolled Medicaid or FAMIS Plus/Medallion recipient under the age of 22 years or a FAMIS enrollee under the age of 19. DMAS - Providing High Quality Comprehensive Health Services

3. Eligibility for EPSDT Screenings • Students enrolled in a Medicaid managed care organization (MCO) must have EPSDT well-child screenings coordinated through the MCO. • School divisions may not bill DMAS directly for EPSDT well-child screenings for MCO enrolled children. DMAS - Providing High Quality Comprehensive Health Services

4. EPSDT Screenings

5. Screening Definition • EPSDT screenings are Medicaid’s well child visits and should occur according to the DMAS periodicity schedule (attached). Providers must obtain a medical history that is inclusive of mental health risk factors and documents the family’s history of mental health conditions. DMAS - Providing High Quality Comprehensive Health Services

6. Screening Content • Regardless of the health care delivery system (whether MCO or FFS), the comprehensive health screening/well child visit content should be in line with the most current recommendations of the American Academy of Pediatrics (AAP), Guidelines for Health Supervision • Another resource for preventive health guidelines is the “Bright Futures/AAP: Guidelines for Health Supervision of Infants, Children, and Adolescents” DMAS - Providing High Quality Comprehensive Health Services

7. EPSDT Screeners • School Health Clinics who employ: • Physician • Certified Nurse Practitioner • Physicians Assistant DMAS - Providing High Quality Comprehensive Health Services

8. Types of Screenings • AAP recommended screenings: • These are typical “well child care” • They are conducted according to the DMAS periodicity schedule DMAS - Providing High Quality Comprehensive Health Services

9. Types of Screenings • Inter-periodic or partial screenings: • These are intermittent physician encounters or “sick visits” • Problem-focused screening DMAS - Providing High Quality Comprehensive Health Services

10. 1 month 2 months 4 months 6 months 9 months 12 months 15 months 18 months 2 years 3 years 4 years 5 years 6 years 8 years 10 years 12 years 14 years 16 years 18 years 20 years Screening Schedule DMAS - Providing High Quality Comprehensive Health Services

11. Mandated Screening Elements • A comprehensive health and developmental history (including assessment of both physical and mental health development); • A comprehensive unclothed physical exam; DMAS - Providing High Quality Comprehensive Health Services

12. Mandated Screening Elements • Vision screening by a standardized testing method according to the DMAS periodicity schedule; • Hearing screening by a standardized testing method according to the DMAS periodicity schedule; • Developmental screening with a standard screening tool according to the American Academy of Pediatrics guidelines; DMAS - Providing High Quality Comprehensive Health Services

13. Mandated Screening Elements Age appropriate immunizations (if needed) Immunizations are scheduled according to: Advisory Committee on Immunization Practices (ACIP) guidelines: http://www.cdc.gov/nip/recs/child-schedule.htm DMAS - Providing High Quality Comprehensive Health Services

14. Mandated Screening Elements • Laboratory tests (including lead blood testing at 12 and 24 months or for a new patient with unknown history up to 72 months or as appropriate for age and risk factors); • Health Education/Anticipatory Guidance/problem-focused guidance and counseling. DMAS - Providing High Quality Comprehensive Health Services

15. Screening and Treatment • The results of the examination may indicate a referral for specific medically necessary Medicaid covered services • Coordinate Treatment needs with the primary care provider DMAS - Providing High Quality Comprehensive Health Services

16. EPSDT Scope of Services • Individualized health care, diagnostic services, and “treatment” as listed in the Federal Medicaid statute, must be provided when medically necessary to correct and ameliorate physical and mental conditions discovered during screening services whether or not included in the state plan DMAS - Providing High Quality Comprehensive Health Services

17. Thank You! EPSDT Coordinator Brian Campbell 804-786-0342 brian.campbell@dmas.virginia.gov DMAS - Providing High Quality Comprehensive Health Services