Early Periodic Screening Diagnostic Treatment (EPSDT) Webinar

Date: April 4, 2023, 11:00 a.m. - 12:00 p.m.

Topics:

• Overview- How this applies to providers
• Authorization and Denials
• Status updates on Claims Configuration
• Diagnosis codes and appropriateness
• NEMT
• Targeted Audits on EPSDT Claims for 2024
• Diagnosis code- Prioritized line
• Opening up diagnosis codes- Z codes and are now easier to use for a larger breadth of diagnosis

EPSDT

Early: Assessing and identifying problems early 

Periodic: Checking children’s health at periodic, age-appropriate intervals 

Screening: Providing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems 

Diagnostic: Performing diagnostic tests to follow up when a risk is identified and 

Treatment: Control, correct or ameliorate (make more tolerable) health problems found. 

EPSDT is a benefit that provides comprehensive and preventive health care services for children and youth under age 21 who are enrolled in Medicaid and the Children’s Health Insurance Plan (CHIP). States are required to provide comprehensive services and furnish all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines. In Oregon, EPSDT constitutes the child and youth benefit within the Oregon Health Plan. 

Effective January 1, 2023, Oregon will implement the full Early and Periodic Screening, Diagnosis and Treatment benefit (EPSDT) for children and youth until their 21st birthday. This means both the Open Card program and coordinated care organizations (CCOs) must cover any medically necessary and medically appropriate services (and dentally appropriate, for dental services) for enrolled children and youth, regardless of:

• The location of the diagnosis on the Prioritized List of Health Services;
• Whether it pairs, or is a non-pairing service;
• Whether it is a previously “non-covered” ancillary service; or
• Whether it is covered under the State Plan.