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Implementing EPSDT and Centennial Care to provide comprehensive health services for children under Medicaid. Care coordination ensures member-centered, family-focused assistance in locating health and social services.
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Anything and Everything Care Coordination: Let’s Put It into Action!
EPSDT/Centennial Care PCP/BH School Nurses SBHC Community Family
Early Periodic Screening Diagnosis Treatment EPSDT The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. Early: Assessing and identifying problems early Periodic : Checking children's health at periodic, age-appropriate intervals Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and Treatment: Control, correct or reduce health problems found. The majority of medicaid services come under the EPSDT benefits
NMAC: http://164.64.110.239 Care Coordination Care Coordinators Are the single point of contact For members and providers. Care Coordinators assist members with their families with complex needs. Care is member centered, family focused and culturally competent. Care Coordinators assists in locating services to meet the health and social needs of the member. The Care Coordination team consists of an integrated BH and PH clinicians and Health Coordinators
Pediatric Care Coordination EPSDT benefits: Well Child exams Dental Vision Personal Care Services Private Duty nursing Therapies Behavioral Health Centennial Care/EPSDT Centennial Care/EPSDT Pediatric Medicaid benefits: Care Coordination Environmental Modifications-conditional Home Health Aide-18 years and older Durable medical equipment Medical Care/Medication Respite-conditional Transportation/lodging Self-direction-conditional/limited
What does this actually look like? At each table together Part One: Use the provided scenarios and develop student health plan Use the provided tools to create the plan Once we are done then we’ll chat about it.
At each table together Part Two: Use the provided scenarios and tools and decide what kind Care Coordination the members need. Remember the majority of benefits and services come from EPSDT Don’t be timid! Be bold! Part three: Now bring them together. How do they work together? Are there gaps or overlaps Any provider can make a referral for care coordination
EPSDT/Centennial Care Resources EPSDT MANUAL: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html BRIEFER VERSION: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/EPSDT_Coverage_Guide.pdf MCO CONTACT INFORMATION: http://www.hsd.state.nm.us/LookingForInformation/managed-care-organizations.aspx EPSDT regulations: http://164.64.110.239/nmac/cgi-bin/hse/homepagesearchengine.exe?url=http://164.64.110.239/nmac/parts/title08/08.320.0002.htm;geturl;terms=epsdt MCO policy manual: http://www.hsd.state.nm.us/providers/managed-care-policy-manual.aspx MCO CONTRACTS:http://www.hsd.state.nm.us/LookingForInformation/medical-assistance-division.aspx NMAC: http://164.64.110.239 Care Coordination and Medicaid: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/epsdt-care-coordination-strategy-guide.pdf
