Early Periodic Screening, Diagnosis and Treatment Program (EPSDT)

Regulation Authority:

42-72-5

Purpose and Reason:

This amended rule updates the practices related to obtaining reimbursement for EPSDT and removes duplicate language. In the amendment of this rule, consideration was given to the following: (1) alternative approaches and (2) overlap or duplication with other statutory and regulatory provisions. No alternative approach or duplication or overlap was identified based upon available information. The title of the final rule is corrected and the final rule revises language in the policy statement to mirror language provided by the Department of Human Services: “EPSDT provides for early prevention care, periodic health evaluation, screening for health defects, diagnosis of health problems, treatment and continuing care. Because EPSDT services include preventive services, they are available at a child's regular visit with his/her doctor. In some cases, where special health care needs are identified, additional services may be available. The Department of Human Services (DHS) provides EPSDT Periodicity Schedules, which provide a schedule for general health, preventative and oral health screening and treatment for children enrolled in the RIte Care plan, as well as Medicaid Fee for Service. These schedules are reviewed and revised periodically and the most current schedule is available on the DHS website.”