EPSDT Services definition

EPSDT Services means services that are within the scope of category of services described as “medical assistance” at Section 1905(a) of the Social Security Act (42 USC 1396d(a)), regardless of whether the service is listed in the Medicaid State Plan or administrative rule, and regardless of whether the service is covered or has limitations for Medicaid beneficiaries 21 years old and older.

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EPSDT Services means early and periodic screening, diagnosis, and treatment services for eligible persons or members less than 21 years of age. For the purpose of these rules:

EPSDT Services includes the delivery of the Federally mandated EPSDT services as set forth in HSD/MAD regulations, 8.320.2 NMAC, EPSDT Services, and the following:

Examples of EPSDT Services in a sentence

• In conjunction with the medical audit, complete EPSDT claims data for the Contractor and a sample of medical records will be evaluated by the Division to determine compliance by the Contractor with the requirements of this Contract for provision of EPSDT Services to Enrollees under age twenty-one (21).

• Screening, Diagnosis and Treatment (EPSDT) Services: As defined by 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 and in Mississippi State Plan, Administrative Code, and written communication to the Contractor.

• The Contractor shall submit Encounter Files to the Department’s Fiscal Agent for each Member who receives EPSDT Services.

• PCPs who serve EPSDT eligible Members, and are qualified EPSDT providers in accordance with Section 5.D, EPSDT Services, of this Contract, are responsible for conducting EPSDT screens for all EPSDT eligible Members on their Panel.

• EPSDT Services/ EPSDT is a package of early and periodic screening, including Services not included in the managed Child Teen Health inter-periodic screens and diagnostic and treatment services care Benefit Package ordered by the Program (C/THP) that are offered to all Medicaid eligible children under child's physician based on the results twenty-one (21) years of age, known in New York State as the of a screening.

• PCPs who serve Members under the age of twenty-one (21), and are qualified EPSDT providers in accordance with Section 5.D, EPSDT Services, of this Contract, are responsible for conducting EPSDT screens for all Members on their Panel under the age of twenty-one (21).

• Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services.

• The Contractor shall submit Encounter Records to the Department’s Fiscal Agent for each Member who receives EPSDT Services.

• In conjunction with the medical audit, complete EPSDT claims data for the Contractor and a sample of medical records will be evaluated by the Division to determine compliance by the Contractor with the requirements of this Contract for provision of EPSDT Services to Enrollees under age 21.

More Definitions of EPSDT Services

EPSDT Services means Early and Periodic Screening, Diagnostic and Treatment services, a benefit of the State's Medi-Cal program that provides comprehensive, preventative, diagnostic, and treatment services to eligible children under the age of 21, as specified in section 1905(r) of the Social Security Act. (42 U.S.C. §§ 1396a(a)(10)(A), 1396a(a)(43), 1396d(a)(4)(B), 1396d(r).) EPSDT Services are key to ensuring members who are eligible receive appropriate preventive, dental, mental health, developmental, and specialty services

EPSDT Services. Comprehensive child health care services to Members under twenty-one (21) years of age, including all medically necessary prevention, screening, diagnosis and treatment services listed in Section 1905 (r) of the Social Security Act. EXTERNAL QUALITY REVIEW ORGANIZATION (EQRO): An entity responsible for conducting reviews of the quality outcomes, timeliness of the delivery of care and access to items and services for which the MCO is responsible under this contract.

EPSDT Services. (added #2(d) and (e) and clarified language in #3 and #4(g)); A.7.19 - Table 17 "Number of Enrollees by Diagnosis" (deleted Table 17 and reserved section); A.

EPSDT Services are specified by 42 USC §§ 1396a(a)(43), 1396d(a) and (r) and 42 CFR Part 441, Subpart B as early and periodic screening, diagnosis and treatment of Covered Persons under age 21 to identify physical and mental defects, illnesses and conditions, and provide treatment to correct or ameliorate the defects, illnesses and conditions discovered thereby, regardless whether services are Covered Services.