Early and Periodic Screening Diagnostic and Treatment (EPSDT) Services Sample Clauses

Early and Periodic Screening Diagnostic and Treatment (EPSDT) Services a. The Contractor must provide EPSDT services as medically necessary in accordance with 42 USC Sec. 1396d(r)(3)(5), 42 CFR part 441, Subpart B, and MSA 16-01 (Appendix M) whether or not such services are covered under the State Plan and without regard to established limits. b. Contractor must have a process that provides services to Enrollees for services not covered under the State Plan that have been determined to be medically necessary. c. The Contractor must provide Enrollees with all covered services in accordance with the Michigan Dental Periodicity Schedule (Appendix L) as adopted from the American Academy of Pediatric Dentistry (AAPD) Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/Counseling. d. Contractor must not have overly burdensome prior authorization requirements for referrals for diagnostic and/or treatment services determined necessary by the Enrollee’s dental provider. This includes, but is not limited to: i. Must make any prior authorization requirements available to its providers ii. Must establish appropriate clinical basis for prior authorization criteria iii. Must respond to prior authorization requests in accordance with 42 CFR 438.210(d), not later than 72 hours for urgent requests and 14 days for routine dental service requests e. Contractor must provide all treatment and diagnostic services as determined necessary by the referring dental provider to correct or ameliorate any conditions found by the referring dental provider. f. Contractor must provide outreach to Enrollees due or overdue for well-child (preventive)/EPSDT visits, including phone, mail, home-visiting or other means of communication acceptable to the Enrollee; the Contractor may meet this requirement by contracting or collaborating with community-based organizations and providers. g. The State will inform HKD beneficiaries of their EPSDT benefits.