Common use of EPSDT Services Clause in Contracts

EPSDT Services. ‌ The Contractor shall comply with Sections 1902(a)(43) and 1905(a)(4)(B) and 1905(r) of the Social Security Act and Federal regulations at 42 C.F.R. Part 441 Subpart B that require EPSDT services to include outreach and informing, screening, tracking, and, diagnostic and treatment services. The Contractor must have written policies and procedures, approved by the Division, related to the provision of the full range of EPSDT services as defined in, and in accordance with, the Division's policies and procedures for EPSDT and the provisions of this Contract. Such services shall include, without limitation, periodic health screenings and appropriate and up- to-date immunizations using the ACIP Recommended Immunization Schedule and AAP Bright Futures of all EPSDT eligible Members, in accordance with the Periodicity Schedule established by the Division for EPSDT services, including periodic examinations for vision, dental, and hearing and all medically necessary services. The Contractor shall identify all EPSDT eligible Members whose Medical Records do not indicate up-to-date immunizations and shall ensure that these Members receive necessary immunizations. The Division requires that the Contractor cooperate to the maximum extent possible with efforts to improve the health status of Mississippi citizens, and to actively work to improve the percentage of Members receiving appropriate screenings. EPSDT wellness (screening) services shall be administered in accordance with Mississippi Administrative Code, State Plan and written communication from the Division to the Contractor. For CMS mandatory reporting purposes, including but not limited to CMS 416 reporting, EPSDT wellness (screening) services must be provided by enrolled Medicaid providers, including, but not limited to, the Mississippi State Department of Health, other public and private agencies, private physicians, Rural Health Clinics, comprehensive health clinics, public schools and/or public school districts certified by the Mississippi Department of Education and similar agencies which provide various components of the EPSDT services, that have signed an EPSDT specific provider agreement with the Division. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. EPSDT providers who have not signed an EPSDT specific agreement with the Division shall not submit claims with preventive Medicine CPT codes. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. Enrolled Medicaid providers who have not signed an EPSDT specific provider agreement with the Division may render EPSDT wellness (screening) services. The Contractor shall not include wellness services rendered by providers who have not signed an EPSDT specific provider agreement with the Division in the Contractors’ reports to the Division. The Contractor must require that EPSDT providers, as defined by the Division, render age appropriate assessment screening services including components defined by the Division. If a suspected problem is detected by a screening examination, the Member must be evaluated as necessary for further diagnosis with referral, if indicated. This diagnosis is used to determine treatment needs. The Contractor must establish a tracking system that provides information on compliance with EPSDT service provision requirements in the following areas: 1. Initial visit for newborns; 2. EPSDT screenings and reporting of all screening results; and 3. Diagnosis, treatment and/or referral for Member. The Contractor must have an established process for reminders, follow-ups and outreach to Members that includes: 1. Written notification of upcoming or missed appointments within a set time period, taking into consideration language and literacy capabilities of Members; 2. Telephone protocols to remind Members of upcoming visits and follow-up on missed appointments within a set time period; 3. If requested, any necessary assistance with arranging for transportation to ensure that Members obtain necessary EPSDT screening services. This assistance must be offered at least three days prior to each due date of a child’s periodic examination; 4. Protocols for conducting outreach with non-compliant Members, including home visits, as appropriate; 5. A process for outreach and follow-up to EPSDT eligible Members with special health care needs; and; 6. For children in ▇▇▇▇▇▇ care only, a process for outreach and follow-up with County Department of Human Services Agencies to assure that they are notified of all EPSDT eligible members who are under their supervision and who are due to receive EPSDT screens and follow-up treatment. 7. The Contractor may develop alternate processes for follow-up and outreach subject to prior written approval from the Division.

EPSDT Services. ‌ The Contractor shall comply with Sections 1902(a)(43) and 1905(a)(4)(B) and 1905(r) of the Social Security Act and Federal regulations at 42 C.F.R. Part 441 Subpart B that require EPSDT services to include outreach and informing, screening, tracking, and, diagnostic and treatment services. The Contractor must have written policies and procedures, approved by the Division, related to the provision of the full range of EPSDT services as defined in, and in accordance with, the Division's policies and procedures for EPSDT and the provisions of this Contract. Such services shall include, without limitation, periodic health screenings and appropriate and up- to-date immunizations using the ACIP Recommended Immunization Schedule and AAP Bright Futures of all EPSDT eligible Members, in accordance with the Periodicity Schedule established by the Division for EPSDT services, including periodic examinations for vision, dental, and hearing and all medically necessary services. The Contractor shall identify all EPSDT eligible Members whose Medical Records do not indicate up-to-date immunizations and shall ensure that these Members receive necessary immunizations. The Division requires that the Contractor cooperate to the maximum extent possible with efforts to improve the health status of Mississippi citizens, and to actively work to improve the percentage of Members receiving appropriate screenings. EPSDT wellness (screening) services shall be administered in accordance with Mississippi Administrative Code, State Plan and written communication from the Division to the Contractor. For CMS mandatory reporting purposes, including but not limited to CMS 416 reporting, EPSDT wellness (screening) services must be provided by enrolled Medicaid providers, including, but not limited to, the Mississippi State Department of Health, other public and private agencies, private physicians, Rural Health Clinics, comprehensive health clinics, public schools and/or public school districts certified by the Mississippi Department of Education and similar agencies which provide various components of the EPSDT services, that have signed an EPSDT specific provider agreement agreement. with the Division. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. EPSDT providers who have not signed an EPSDT specific agreement with the Division shall not submit claims with preventive Medicine CPT codes. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. Enrolled Medicaid providers who have not signed an EPSDT specific provider agreement with the Division may render EPSDT wellness (screening) services. The Contractor shall not include wellness services rendered by providers who have not signed an EPSDT specific provider agreement with the Division in the Contractors’ reports to the Division. The Contractor must require that EPSDT providers, as defined by the Division, render age appropriate assessment screening services including components defined by the Division. If a suspected problem is detected by a screening examination, the Member must be evaluated as necessary for further diagnosis with referral, if indicated. This diagnosis is used to determine treatment needs. The Contractor must establish a tracking system that provides information on compliance with EPSDT service provision requirements in the following areas: 1. Initial visit for newborns; 2. EPSDT screenings and reporting of all screening results; and 3. Diagnosis, treatment and/or referral for Member. The Contractor must have an established process for reminders, follow-ups and outreach to Members that includes: 1. Written notification of upcoming or missed appointments within a set time period, taking into consideration language and literacy capabilities of Members; 2. Telephone protocols to remind Members of upcoming visits and follow-up on missed appointments within a set time period; 3. If requested, any necessary assistance with arranging for transportation to ensure that Members obtain necessary EPSDT screening services. This assistance must be offered at least three days prior to each due date of a child’s periodic examination; 4. Protocols for conducting outreach with non-compliant Members, including home visits, as appropriate; 5. A process for outreach and follow-up to EPSDT eligible Members with special health care needs; and; 6. For children in ▇▇▇▇▇▇ care only, a process for outreach and follow-up with County Department of Human Services Agencies to assure that they are notified of all EPSDT eligible members who are under their supervision and who are due to receive EPSDT screens and follow-up treatment. 7. The Contractor may develop alternate processes for follow-up and outreach subject to prior written approval from the Division.

EPSDT Services. ‌ The Contractor shall comply with Sections 1902(a)(43) and 1905(a)(4)(B) and 1905(r) of the Social Security Act and Federal regulations at 42 C.F.R. Part 441 Subpart B that require EPSDT services to include outreach and informing, screening, tracking, and, diagnostic and treatment services. The Contractor must have written policies and procedures, approved by the Division, related to the provision of the full range of EPSDT services as defined in, and in accordance with, the Division's policies and procedures for EPSDT and the provisions of this Contract. Such services shall include, without limitation, periodic health screenings and appropriate and up- to-date immunizations using the ACIP Recommended Immunization Schedule and AAP Bright Futures of all EPSDT eligible Members, in accordance with the Periodicity Schedule established by the Division for EPSDT services, including periodic examinations for vision, dental, and hearing and all medically necessary services. The Contractor shall identify all EPSDT eligible Members whose Medical Records do not indicate up-to-date immunizations and shall ensure that these Members receive necessary immunizations. The Division requires that the Contractor cooperate to the maximum extent possible with efforts to improve the health status of Mississippi citizens, and to actively work to improve the percentage of Members receiving appropriate screenings. EPSDT wellness (screening) services shall be administered in accordance with Mississippi Administrative Code, State Plan and written communication from the Division to the Contractor. For CMS mandatory reporting purposes, including but not limited to CMS 416 reporting, EPSDT wellness (screening) services must be Contractor and provided by enrolled Medicaid providers, including, but not limited to, the Mississippi State Department of Health, other public and private agencies, private physicians, Rural Health Clinics, comprehensive health clinics, public schools and/or public school districts certified by the Mississippi Department of Education and similar agencies which provide various components of the EPSDT services, that have signed an EPSDT specific provider agreement with the Divisionagreement. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. EPSDT providers who have not signed an EPSDT specific agreement with the Division shall not submit claims with preventive Medicine CPT codes. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. Enrolled Medicaid providers who have not signed an EPSDT specific provider agreement with the Division may render EPSDT wellness (screening) services. The Contractor shall not include wellness services rendered by providers who have not signed an EPSDT specific provider agreement with the Division in the Contractors’ reports to the Division. The Contractor must require that EPSDT providers, as defined by the Division, render age appropriate assessment screening services including components defined by the Division. If a suspected problem is detected by a screening examination, the Member must be evaluated as necessary for further diagnosis with referral, if indicated. This diagnosis is used to determine treatment needs. The Contractor must establish a tracking system that provides information on compliance with EPSDT service provision requirements in the following areas: 1. Initial visit for newborns; 2. EPSDT screenings and reporting of all screening results; and 3. Diagnosis, treatment and/or referral for Member. The Contractor must have an established process for reminders, follow-ups and outreach to Members that includes: 1. Written notification of upcoming or missed appointments within a set time period, taking into consideration language and literacy capabilities of Members; 2. Telephone protocols to remind Members of upcoming visits and follow-up on missed appointments within a set time period; 3. If requested, any necessary assistance with arranging for transportation to ensure that Members obtain necessary EPSDT screening services. This assistance must be offered at least three days prior to each due date of a child’s periodic examination; 4. Protocols for conducting outreach with non-compliant Members, including home visits, as appropriate; 5. A process for outreach and follow-up to EPSDT eligible Members with special health care needs; and; 6. For children in ▇▇▇▇▇▇ care only, a process for outreach and follow-up with County Department of Human Services Agencies to assure that they are notified of all EPSDT eligible members who are under their supervision and who are due to receive EPSDT screens and follow-up treatment. 7. The Contractor may develop alternate processes for follow-up and outreach subject to prior written approval from the Division.

EPSDT Services. ‌ The Contractor shall comply with Sections 1902(a)(43) and 1905(a)(4)(B) and 1905(r) of the Social Security Act and Federal regulations at 42 C.F.R. Part 441 Subpart B that require EPSDT services to include outreach and informing, screening, tracking, and, diagnostic and treatment services. The Contractor must have written policies and procedures, approved by the Division, related to the provision of the full range of EPSDT services as defined in, and in accordance with, the Division's policies and procedures for EPSDT and the provisions of this Contract. Such services shall include, without limitation, periodic health screenings and appropriate and up- up-to-date immunizations using the ACIP Recommended Immunization Schedule and AAP Bright Futures of all EPSDT eligible MembersMembers under twenty-one (21), in accordance with the Periodicity Schedule established by the Division for EPSDT services, including periodic examinations for vision, dental, and hearing and all medically necessary services. The Contractor shall identify all EPSDT eligible Members under twenty- one (21) whose Medical Records do not indicate up-to-date immunizations and shall ensure that these Members receive necessary immunizations. The Division requires that the Contractor cooperate to the maximum extent possible with efforts to improve the health status of Mississippi citizens, and to actively work to improve the percentage of Members receiving appropriate screenings, and meet or exceed the percentage of screenings for the Medicaid Fee-for-Service population. EPSDT wellness (screening) services shall be administered in accordance with Mississippi Administrative Code, State Plan and written communication from the Division to the Contractor. For CMS mandatory reporting purposes, including but not limited to CMS 416 reporting, EPSDT wellness (screening) services must be Contractor and provided by enrolled Medicaid providers, including, but not limited to, the Mississippi State Department of Health, other public and private agencies, private physicians, Rural Health Clinics, comprehensive health clinics, public schools and/or public school districts certified by the Mississippi Department of Education and similar agencies which provide various components of the EPSDT services, that have signed an EPSDT specific provider agreement with the Divisionagreement. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. EPSDT providers who have not signed an EPSDT specific agreement with the Division shall not submit claims with preventive Medicine CPT codes. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. Enrolled Medicaid providers who have not signed an EPSDT specific provider agreement with the Division may render EPSDT wellness (screening) services. The Contractor shall not include wellness services rendered by providers who have not signed an EPSDT specific provider agreement with the Division in the Contractors’ reports to the Division. The Contractor must require that EPSDT providers, as defined by the Division, render age appropriate assessment screening services including components defined by the Division. If a suspected problem is detected by a screening examination, the Member must be evaluated as necessary for further diagnosis with referral, if indicateddiagnosis. This diagnosis is used to determine treatment needs. The Contractor must establish a tracking system that provides information on compliance with EPSDT service provision requirements in the following areas: 1. Initial visit for newborns; 2. EPSDT screenings and reporting of all screening results; and 3. Diagnosis, Diagnosis and/or treatment and/or referral for Member. The Contractor must have an established process for reminders, follow-ups and outreach to Members that includes: 1. Written notification of upcoming or missed appointments within a set time period, taking into consideration language and literacy capabilities of Members; 2. Telephone protocols to remind Members of upcoming visits and follow-up on missed appointments within a set time period; 3. If requested, any necessary assistance with arranging for transportation to ensure that Members obtain necessary EPSDT screening services. This assistance must be offered at least three days prior to each due date of a child’s periodic examination; 4. Protocols for conducting outreach with non-compliant Members, including home visits, as appropriate; 5. A process for outreach and follow-up to EPSDT eligible Members under the age of twenty-one (21) with special health care needs; and; 6. For children in ▇▇▇▇▇▇ care only, a process for outreach and follow-up with County Department of Human Services Agencies to assure that they are notified of all EPSDT eligible members Members under the age of twenty-one (21) who are under their supervision and who are due to receive EPSDT screens and follow-up treatment. 7. The Contractor may develop alternate processes for follow-up and outreach subject to prior written approval from the Division.

EPSDT Services. ‌ The Contractor shall comply with Sections 1902(a)(43) and 1905(a)(4)(B) and 1905(r) of the Social Security Act and Federal regulations at 42 C.F.R. Part 441 Subpart B that require EPSDT services to include outreach and informing, screening, tracking, and, diagnostic and treatment services. The Contractor must have written policies and procedures, approved by the Division, related to the provision of the full range of EPSDT services as defined in, and in accordance with, the Division's policies and procedures for EPSDT and the provisions of this Contract. Such services shall include, without limitation, periodic health screenings and appropriate and up- to-date immunizations using the ACIP Recommended Immunization Schedule and AAP Bright Futures of all EPSDT eligible Members, in accordance with the Periodicity Schedule established by the Division for EPSDT services, including periodic examinations for vision, dental, and hearing and all medically necessary services. The Contractor shall identify all EPSDT eligible Members whose Medical Records do not indicate up-to-date immunizations and shall ensure that these Members receive necessary immunizations. The Division requires that the Contractor cooperate to the maximum extent possible with efforts to improve the health status of Mississippi citizens, and to actively work to improve the percentage of Members receiving appropriate screenings. EPSDT wellness (screening) services shall be administered in accordance with Mississippi Administrative Code, State Plan and written communication from the Division to the Contractor. For CMS mandatory reporting purposes, including but not limited to CMS 416 reporting, EPSDT wellness (screening) services must be provided by enrolled Medicaid providers, including, but not limited to, the Mississippi State Department of Health, other public and private agencies, private physicians, Rural Health Clinics, comprehensive health clinics, public schools and/or public school districts certified by the Mississippi Department of Education and similar agencies which provide various components of the EPSDT services, that have signed an EPSDT specific provider agreement agreement. with the Division. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. EPSDT providers who have not signed an EPSDT specific agreement with the Division shall not submit claims with preventive Medicine CPT codes. The Division will provide the Contractor with a list of qualified EPSDT providers on a monthly basis. Enrolled Medicaid providers who have not signed an EPSDT specific provider agreement with the Division may render EPSDT wellness (screening) services. The Contractor shall not include wellness services rendered by providers who have not signed an EPSDT specific provider agreement with the Division in the Contractors’ reports to the Division. The Contractor must require that EPSDT providers, as defined by the Division, render age appropriate assessment screening services including components defined by the Division. If a suspected problem is detected by a screening examination, the Member must be evaluated as necessary for further diagnosis with referral, if indicated. This diagnosis is used to determine treatment needs. The Contractor must establish a tracking system that provides information on compliance with EPSDT service provision requirements in the following areas: 1. Initial visit for newborns; 2. EPSDT screenings and reporting of all screening results; and 3. Diagnosis, treatment and/or referral for Member. The Contractor must have an established process for reminders, follow-ups and outreach to Members that includes: 1. Written notification of upcoming or missed appointments within a set time period, taking into consideration language and literacy capabilities of Members; 2. Telephone protocols to remind Members of upcoming visits and follow-up on missed appointments within a set time period; 3. If requested, any necessary assistance with arranging for transportation to ensure that Members obtain necessary EPSDT screening services. This assistance must be offered at least three days prior to each due date of a child’s periodic examination; 4. Protocols for conducting outreach with non-compliant Members, including home visits, as appropriate; 5. A process for outreach and follow-up to EPSDT eligible Members with special health care needs; and; 6. For children in ▇▇▇▇▇▇ care only, a process for outreach and follow-up with County Department of Human Services Agencies to assure that they are notified of all EPSDT eligible members who are under their supervision and who are due to receive EPSDT screens and follow-up treatment. 7. The Contractor may develop alternate processes for follow-up and outreach subject to prior written approval from the Division.