Provider Alerts - February 22, 2019

Requirements for Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT)

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Date: February 21, 2019
To: Health Plan of San Joaquin (HPSJ) Providers
From: HPSJ Medical Management Department
Subject: Requirements for Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT)
Business: Medi-Cal

Health Plan of San Joaquin contracted Primary Care Providers are required to screen children under the age of 21. All members under 21 years of age must receive EPSDT screening to identify health and developmental issues as early as possible. The EPSDT benefit is designed to ensure that eligible children receive comprehensive screening, diagnostic, treatment, and preventative health care services so that health problems are averted or diagnosed and treated as early as possible.

The EPSDT benefit also includes medically necessary diagnostic and treatment services for members with developmental issues, when a screening examination indicates the need for further evaluation of a child’s health. The member should be appropriately referred for diagnosis and treatment without delay. HPSJ is responsible for providing medically necessary Behavioral Health Treatment (BHT) services for members with Autism and non Autism that meet eligibility criteria for services.

Screening requirements are:

  • Health Screening
  • Vision
  • Hearing
  • Dental

HPSJ will cover and ensure the provision of screening, preventive, and medically necessary diagnostic and treatment services. If you have questions about this alert, please call UM at (209) 942-6350.

Source: CA DHCS APL-18-007
https://www.dhcs.ca.gov/formsandpubs/Pages/AllPlanLetters.aspx

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