Epsdt And Medical Necessity

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Early and Periodic Screening, Diagnostic, and Treatment

https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html

EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. ... It is the responsibility of states to determine medical necessity on a case-by-case basis. ... for …

Considerations in the Determination of Medical …

https://publications.aap.org/pediatrics/article/150/3/e2022058882/188901/Considerations-in-the-Determination-of-Medical

The impact of the EPSDT mandate in framing the requirements for a robust and comprehensive medical necessity approach is significant because Medicaid and …

Provider Information | Medi-Cal for Kids & Teens

https://www.dhcs.ca.gov/services/Medi-Cal-For-Kids-and-Teens/Pages/Provider-Information.aspx

Medical Necessity. Medi-Cal for Kids & Teens (the EPSDT benefit) allows enrolled members (under age 21) to receive any medically necessary treatment or procedure, …

EPSDT in Medicaid : MACPAC

https://www.macpac.gov/subtopic/epsdt-in-medicaid/

Benefits. All children under age 21 enrolled in Medicaid through the categorically needy pathway are entitled to the Early and Periodic Screening, Diagnostic, and Treatment …

State Definitions of Medical Necessity under the Medicaid EPSDT …

https://nashp.org/state-definitions-of-medical-necessity-under-the-medicaid-epsdt-benefit/

Medical necessity for EPSDT services is defined under 8.282.4.E For the purposes of EPSDT, medical necessity includes a good or service that will, or is reasonably …

EPSDT - Medi-Cal

https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/epsdt.pdf

Part 2 – EPSDT Page updated: June 2022 Medical Necessity The standards to meet medical necessity differ between Medi-Cal and EPSDT. The EPSDT standard is as …

EPSDT - A Guide for States - HHS.gov

https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/epsdt_coverage_guide_11.pdf

states use this data to monitor EPSDT performance. This guide is intended to help states, health care providers and others to understand the scope of services that are covered …

Early and Periodic Screening, Diagnostic and Treatment …

https://hcpf.colorado.gov/early-and-periodic-screening-diagnostic-and-treatment-epsdt

EPSDT Medical Necessity Does NOT include: Experimental or investigational treatments, Services or items not generally accepted as effective, and/or not within the normal course …

Children and Family Treatment and Support Services

https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/proposed_spa.htm

Children and Family Treatment and Support Services. SPA services are Rehabilitative services under the EPSDT benefit and available to children/youth under the age of 21 …

1991-EPSDT-Medical-Necessity | Guidance Portal

https://www.hhs.gov/guidance/document/1991-epsdt-medical-necessity

1991-EPSDT-Medical-Necessity. Guidance for: This letter provides clarification on Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) …

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