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What is EPSDT & Why Is It Important to Behavior Health Providers?

Taken from the Colorado Access website:

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is Medicaid’s comprehensive benefit package for children ages birth through 20 years. It is designed to enhance primary care with emphasis on prevention and early intervention. EPSDT goes beyond the scope of the adult Medicaid benefit package. EPSDT includes well-child check-ups, sick care, treatments, care coordinators, and wrap-around benefits.

In 1989, Congress expanded the scope of EPSDT services. States must now cover regular and periodic examinations for all children covered by Medicaid younger than 21 years of age. They also must provide any medically necessary services indicated by the examination findings; even services that may not be covered by a member’s Medicaid health plan. Treatments and services that are not included in a Medicaid HMO’s plan but are covered by the State Medicaid program are called wrap-around benefits, such as dental care, orthodontia for severe malocclusion, and behavioral health care.

Under EPSDT, children who have Medicaid are entitled to evaluation and treatment of mental health issues. The EPSDT program facilitates mental health care by means of the comprehensive health screening, performed by the child’s PCP. When the PCP identifies a member who is in need of behavioral health care the member should be referred to the appropriate Behavioral Health Organization (BHO) for follow-up evaluation and appropriate treatment. BHO providers are required to accept referrals of children and adolescents screened through the EPSDT program, and to coordinate services with the child’s primary care physician.

As part of an initial mental health assessment, Access Behavioral Care providers should attempt to determine whether a child or adolescent has received a comprehensive EPSDT health screening. If so, the provider should obtain a release of information from the parent or guardian to obtain and review the results of EPSDT screening, and coordinate medical and behavioral health care. If not, the provider should attempt to refer the consumer to a PCP to perform an EPSDT screening. Access Behavioral Care Resource Coordinators can help facilitate this linkage. They can be reached at 303-751-9030 or 1-800-984-9133.

The periodic schedule for EPSDT screenings, adopted from the American Academy of Physicians (AAP), is as follows:

  • At birth
  • 2 to 4 days, if the newborns left the hospital < 48 hours after delivery
  • by 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 15 months
  • 18 months
  • Once every year for ages 2 to 20

A comprehensive EPSDT screening should include, but is not limited to, the following:

  • Unclothed physical examination
  • Immunizations as needed
  • Lab tests as needed
  • Mandatory blood lead testing at 12 and 24 months (or up to age 6 if not previously screened)
  • Health and developmental history
  • Nutritional assessment
  • Developmental assessment
  • Mental/behavioral health assessment
  • Adolescent family planning
  • Dental screening
  • Vision screening
  • Hearing screening
  • Health education and anticipatory guidance
  • Diagnosis, treatment and referrals

If you would like more information concerning EPSDT, please contact Colorado Access' Health Outcomes Coordinator by clicking on this email link.