Coordination between Medicaid and Title V agencies — states and nonprofits that promote maternal and child health — is mandatory (42 CFR 431.615, HRSA 2016). Medicaid and Title V agencies and fellows deal with many of the same population groups and contracts with many of the same providers. The national agencies in Title V have followed the coordination in different ways, for example. B in the development of EPSDT provisions in management care contracts, in the control of network adequacy and in the development of EPSDT standards (HRSA 2016). In 2014, the average participation rate was 59% on a federal average (CMS 2016). Between 2006 and 2013, only eight States achieved at least once a participation rate of 80% (OIG 2014). In FY2014, participation rates were highest among infants under one year of age (88%), compared to 43% for 15-18 year olds and 25% for 19-20 year olds (CMS 2016). Dates of participation. States electronically transmit epsdt information to the CMS using a form called CMS-416.

The reported data include the participation rate, which represents the percentage of children who were expected to receive at least one screening who received such screening. Additional measures include the number of children eligible for EPSDT, the number of children transferred for corrective treatment and the number of children receiving preventive or diagnostic dental care. States report these data by age (CMS 2014). CMS uses information from CMS-416 to ensure that public programs comply with legal obligations under the EPSDT (GAO 2009). EPSDT was introduced as part of the amendments to the Social Security Act 1967. Subsequent legislative changes resulted in standards for identifying children who need screening, screening, coverage of diagnosis and treatment, and coordination between Medicaid and external agencies for the provision of services that Medicaid does not cover (42 CFR 441, Rosenbaum 2002 Memo to SAMHSA). [2] Qualified suppliers. Any provider operating as part of their practice under state law, whether or not they participate in Medicaid, may perform screening that triggers EPSDT coverage (CMS 2014a). The family does not need to apply for formal EPSDT screening to obtain EPSDT benefits and the screening did not have to have been done while the child was enrolled in Medicaid. However, families who see providers who do not participate in Medicaid or their management care plan without prior authorization are usually responsible for the bill.

There are exceptions for emergency and post-stabilization care services in the event of an emergency (42 CFR 438.114). . . .