Medical Necessity Under The Epsdt Program

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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

Early and Periodic Screening, Diagnostic, and Treatment. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in …

State Definitions of Medical Necessity under the Medicaid EPSDT …

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

State Administrative code 560-x-11-.14 defines medical necessity for EPSDT services as follows: ...

EPSDT in Medicaid : MACPAC

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

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

Early Periodic Screening, Diagnosis, and Treatment

https://mchb.hrsa.gov/programs-impact/early-periodic-screening-diagnosis-treatment

In particular, coordination with the Medicaid Early Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is required. The EPSDT benefit provides comprehensive …

EPSDT - A Guide for States - HHS.gov

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

EPSDT’s screening requirements, including when interperiodic screening should be provided; Scope of services covered under EPSDT; EPSDT’s requirements governing …

Early and Periodic Screening, Diagnostic and …

https://hcpf.colorado.gov/sites/hcpf/files/EPSDT%20Fact%20Sheet.pdf

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children and youth ages 20 and …

Medicaid Funding for ABA: A Clinician’s Guide to Medicaid Funding

https://centralreach.com/medicaid-funding-for-aba-a-guide-for-clinicians/

Any services that qualify under the EPSDT program are only authorized if necessary to correct or alleviate a physical or mental health condition. In other words, …

EPSDT Provider Education

https://www.oregon.gov/oha/HPA/dsi-tc/Documents/EPSDT%20BH%20Provider%20Webinar_2.15.23%20FINAL.pdf

• Under EPSDT, CCOs and OHA must cover all medically necessary and appropriate (or dentally appropriate, in the case of a dental service) services ... Diagnostic and …

Early and Periodic Screening, Diagnostic and Treatment …

https://www.oregon.gov/oha/HSD/OHP/Pages/EPSDT.aspx

Medical necessity and medical appropriateness are determined on a case-by-case basis, taking into account the member's needs. States must cover all medically necessary and …

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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