General definition


CO | CT | DC | FL | HI | IL | IN | KS | KY | ME | MD | MA | MI | MN | MO | MT | NV | NJ | NM
NY | NC | ND | OH | OK | RI | SC | TX | UT | VA

 
CO

"I. DEFINITIONS
The following terms as used in this Contract shall be construed and interpreted as follows unless the context otherwise expressly requires a different construction and interpretation: …

AG.  'EPSDT' shall mean the Early, Periodic, Screening, Diagnosis, and Treatment Program which provides comprehensive health care for children through periodic screenings, diagnostic and treatment services."  Colorado Contract, page 5.

CT

"SUMMARY DESCRIPTION OF BENEFITS
A.  Covered Services included in the Capitation Payment...
  28.  Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services - Comprehensive child health care services to recipients 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…"  Connecticut Contract, Appendix A, pages 3-10.

"Part II:  General Contract Terms for MCOs
1.  Definitions...
O.  EPSDT Case Management Services:  Services such as making and facilitating referrals and development and coordination of a plan of services that will assist Members under 21 years of age in gaining access to needed medical, social, educational, and other services.
P.  EPSDT Diagnostic and Treatment Services:  All health care, diagnostic services, and treatment necessary to correct or ameliorate defects and physical and mental illnesses and conditions discovered by an interperiodic or periodic EPSDT screening examination.
Q.  EPSDT Screening Services:  Comprehensive, periodic health examinations for Members under the age of 21 provided in accordance with the requirements of the federal Medicaid statute at 42 U.S.C. §1396d(r)(1);
R.  EPSDT Services:  Comprehensive child health care services to recipients under 21 years of age, including all medically necessary prevention, screening, diagnosis and treatment services listed in Section 1905(r) of the Social Security Act…"  Connecticut Contract, pages 11-13.

DC

"ARTICLE XXII - DEFINITIONS...
M.  The Term 'Early Periodic Screening, Diagnosis and Treatment (EPSDT)' shall mean  the pediatric component of the Medicaid program and created and implement by federal  statute and regulations."  District of Columbia Contract, pages 48, 50.

FL

"9.  Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services.  EPSDT services are comprehensive and preventive health examinations provided on a periodic basis that are aimed at identifying and correcting medical conditions in children and young people (birth through 20 years of age) before the conditions become serious and disabling..."  Florida Contract, page 83.

"Amendment 001...
10.  The following contract reference to Early and Periodic Screening, Diagnosis and Treatment (EPSDT) are deleted and replaced with Child Health Check Up…"  Florida Contract, page 6.

HI

"30.730  Children's Medical and Behavioral Health Services (EPSDT) Services...
EPSDT emphasizes the importance of prevention, early detection of medical, dental and behavioral health conditions and timely treatment of conditions detected as a result of screening...
*  Early - A child's health is assessed as early as possible in the child's life in order to prevent or find potential diseases and disabilities in their early stages, when they are most effectively treated.
*  Periodic - Assessing a child's health at regularly scheduled intervals to assure that a condition, illness, or injury is not incipient or present.
*  Screening - A comprehensive child health assessment to determine if a child has a condition, illness or injury that should be referred for more definitive evaluation and/or treatment.
*  Diagnosis - The definitive evaluation by appropriate medical petitioners to determine the nature, extent or cause of a condition, illness, or injury.
*  Treatment - The medical and remedial services permitted under Medicaid and determined medically necessary for problems identified during screening or diagnostic procedures." Hawaii RFP, page 23.

IL

"EPSDT means the Early and Periodic, Screening, Diagnostic and Treatment services provided to children under Title XIX of the Social Security Act (42 U.S.C. § 1396, et seq.)."  Illinois HMO Contract, page 4.

IN

"Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Services - Those services described at 405 IAC 5-15 as required by Federal law pursuant to 42 U.S.C. 1396d(r), which include certain preventive services to children under 21 years of age. "  Indiana RFP, page 1-3.

KS

"K.  KAN BE HEALTHY
KAN Be Healthy Background and Definition
Federal law and regulations governing the administration of the Medicaid Program require that a state provide health screening and necessary diagnostic and treatment services for all children under age twenty-one who are eligible for Medicaid. The program is called Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and is called KAN Be Healthy (KBH) in Kansas… The concept that child health services should be continuing arid comprehensive is basic. A child should be able to receive examination, treatment, and when necessary, referral services from one provider to another provider. This program allows participating individuals under the age of twenty-one (21) to receive any services which are medically necessary. In order to be considered a program participant and receive additional services, individuals must follow the screening schedule defined below."  Kansas General Service, page 14.

"Early Periodic Screening, Diagnosis, and Treatment (EPSDT) - a program of preventive health care, well child examinations with appropriate tests and immunizations.  Called the KAN Be Healthy Program in Kansas."  Kansas Contract, Appendix E, page 2.

"KAN Be Healthy - the name of the federally mandated Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program in Kansas."  Kansas Contract, Appendix E, page 4.

KY

"EPSDT means Early and Periodic Screening, Diagnosis and Treatment Program."  Kentucky Contract, page 12."

ME

"II.  DEFINITIONS.
A.  The following terms used in this Contract shall be interpreted as defined herein, except to the extent that the context may clearly require otherwise: ...
19.  Early and Periodic Screening, Diagnosis and Treatment ('EPSDT') is the Medicaid program whereby recipients under 21 receive certain preventive care services on a regular basis."  Maine Contract, pages 2, 4.

MD

"Chapter 62  Maryland Medicaid Managed Care Program:  Definitions
.01  Definitions…
(42)  'Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)' means the provision, to individuals younger than 21 years old, of preventive health care pursuant to 42 CFR §441.50 et seq. (1981), and other health care services, diagnostic services, and treatment services that are necessary to correct or ameliorate defects and physical and mental illnesses and conditions discovered by EPSDT screening services."  Maryland COMAR 10.09.62.01.

MA

"SECTION 1.  DEFINITION OF TERMS...
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) - the delivery of health care services to Members under the age of 22, pursuant to 130 CMR 450.140-149…"  Massachusetts Contract, pages 6-9.

MI

"DEFINITIONS/ EXPLANATION OF TERMS...

Well Child Visits/EPSDT
Early and periodic screening, diagnosis, and treatment program.  A child health program of prevention and treatment intended to ensure availability and accessibility of primary, preventive, and or the necessary health care resources and to help Medicaid children and their families to effectively use these resources."  Michigan Contract, pages vi, xi

"II-I  SPECIAL COVERAGE PROVISIONS...
9. Well Child care/Early and Periodic Screening, diagnosis & treatment (EPSDT)

Well Child/EPSDT is a Medicaid child health program of early and periodic screening, diagnosis and treatment services for children, adolescents, and young adults under the age or 21…"  Michigan Contract, pages 22, 27.

MN

"Section 2.14. EPSDT (or C&TC) means the Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) Program required under 42 C.F.R. 441.50, known in Minnesota as the Child and Teen Checkup (C&TC) Program, that provides comprehensive health services for MA-eligible children under age 21."  Minnesota Contract, page 11.

"Section 6.1.3. Child and Teen Checkup. The Health Plan agrees to provide, or arrange to provide Child and Teen Checkup (C&TC) screenings to each Enrollee under age 21, as follows, and shall be subject to 42 U.S.C. Section 1396d(r): …
D. The HEALTH PLAN must:
1)  notify Enrollees under the age of 21 of the availability of C&TC screening at least annually;
2)  provide all of the required screening components according to the C&TC standards and periodicity schedule (although the HEALTH PLAN may offer additional preventive services beyond these minimal standards); and
3)  provide all Medically Necessary health care, diagnostic services, treatments and other measures, to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, which are mandatory or optional MA--covered services under 42 U.S.C Section 1396d(a). See 42 U.S.C. Section 1396d(r)(5)."  Minnesota Contract, pages 50-51.

MO

"2.6.2  Early Periodic Screening, Diagnosis, and Treatment Services: The Omnibus Budget Reconciliation Act of 1989 (OBRA 89) mandated that all medically necessary services listed in section 1905 (a) of the Social Security Act be covered under Medicaid for the Early Periodic Screening, Diagnosis, and Treatment Services benefit provided for Medicaid eligible children under the age of 21 years.  In Missouri this program is known as the Healthy Children and Youth (HCY) Program.  The health plan must have written policies and procedures for conducting outreach and education of children eligible for the HCY program, for providing the full early and periodic screening, diagnosis, and treatment services to all eligible children and young adults up to age 21 and for standardization documentation of screenings using either the State HCY screening form (see Attachment 11) or a similar form. The full scope of early and periodic, screening, diagnosis, and treatment service requirements is described below: …"  Missouri RFP, page 52.

MT

"EPSDT- a MEDICAID program of health screening and necessary diagnostic and treatment services for all CHILDREN under age twentyone who are eligible for MEDICAID."  Montana  Contract, page 27.

"HMO/EPSDT POLICIES AND PROCEDURES
Background...
The concept that child health services should be continuing and comprehensive is basic.  A child should be able to receive examination, treatment and when necessary, referral services from one PROVIDER.  EPSDT services ideally should be part of a continuum of care so that the child's screening services are delivered by someone familiar with the child's episodes of acute illness and who has an ongoing relations with the family as the regular source of the child's health care.  Continuing care PROVIDERS can make a variety of services available and continuously monitor and advise on a child's development.

Screening, Diagnosis, and Treatment...
Screening is not an end in itself, but the first step in the detection process which includes diagnosis.  Similarly, the detection process, without treatment for conditions found, does not improve health and is not an end in itself.  Each step in EPSDT process is essential for EPSDT program that contributes for children's health."  Montana Contract, page 56.

NV

"DEFINITIONS...
EPSDT:  Early and periodic screening, diagnosis, and treatment program.  This is a preventive and comprehensive health program for Medicaid-eligible individuals under age 21, required under Title XIX of the Social Security Act...  The State must ensure the following services are provided; The services include, but are not limited to, dental care, appropriate immunizations, lead screening, and vision and hearing treatment, including eye glasses, and hearing aids.  Refer to 1902(a)(43), 1905(a)(4)(B), and 1905(r) of the Social Security Act, and 42 CFR 441.50 through 441.62 for details.  Services not medically necessary, or rendered merely to serve an academic purpose are not a Nevada Medicaid EPSDT program benefit and the costs incurred are not reimbursed by Nevada Medicaid.  Contractors will not be required to provide or reimburse for services not medically necessary, or rendered only to serve an academic purpose."  Nevada Contract, page 16.

NJ

"1.42  'EPSDT' means the Early and Periodic, Screening, Diagnosis and Treatment program within the Medicaid program, mandated by Title XIX of the Social Security Act."  New Jersey Contract, page 13.

“ATTACHMENT I
EPSDT PROTOCOL...
The contractor must provide EPSDT equivalent services. EPSDT is a federally mandated comprehensive child health program for Medicaid recipients from birth through 20 years of age. Section 1905(r) of the Social Security Act (42 U.S.C. 1396(d) and federal regulation 42 CFR 441.50 et seq. defines EPSDT services…"  New Jersey Contract, Attachment I, page 172.

NM

"2.d.16 EPSDT Services:
The benefit package includes the delivery of the Federally mandated Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services as set in for the Medical Assistance Division Program Manual Section MAD-740, EPSDT SERVICES." New Mexico Contract, page 39.

NY

"1.  DEFINITIONS...
'Child/Teen Health Program' or 'C/THP' means the program of early and periodic screening, including inter-periodic, diagnostic and treatment services (EPSDT) that New York State offers all Medicaid eligible children under twenty-one (21) years of age...The services include administrative services designed to help families obtain services for children including outreach, information, appointment scheduling, administrative case management and transportation assistance, to the extent that transportation is included in the Benefit Package…"  New York Contract, page 1-1.

NC

"APPENDIX I
DEFINITION OF TERMS...
1.35  Health Check - A child health program for recipients through the age of twenty (20) designed to improve the availability and accessibility of preventive and primary health care services.  It is sponsored by the Division."  North Carolina Contract, Appendix I.

ND

"EPSDT - See, Health Tracks...
Health Tracks - A Medicaid program of health screening and necessary diagnostic and treatment services for all children under age 21 who are eligible for Medicaid."  North Dakota Contract, Attachment C, pages 3, 5.

OH

"5101:3-26-01  Managed care plan:  Definitions.
As used in Chapter 5101:3-26 of the Administrative Code: …
(GG)  'Healthchek,' otherwise known as the early and periodic screening, diagnosis, and treatment (EPSDT) program, is a program of comprehensive preventive health services available to Medicaid recipients from birth through twenty years of age.  The program is designed to maintain health by providing early intervention to discover and treat health problems."  Ohio RFP, Appendix E, OAC 5101:3-26-01, page 1.

OK

"1.4  Definitions
Each of the following terms shall have the indicated meanings unless the context clearly requires otherwise: ...

27.  EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) is a program defined by 42 U.S.C. §1396a(a)(43) and d(r) which covers screening and diagnostic services for enrollees under the age of 21 to determine physical and mental defects and to ascertain health care treatment and other measures to correct or ameliorate any existing defects and/or chronic conditions discovered…"  Oklahoma RFP, pages 5, 7.

RI

"ARTICLE I:  DEFINITIONS...
1.06  EPSDT
EPSDT means Early Periodic Screening, Diagnosis and Treatment, a comprehensive set of services provided to all eligible children under age 21…"  Rhode Island RFP, page 1.

SC

"4.2  Early and Periodic Screening. Diagnosis and Treatment (EPSDT)/Well Child Visits...
EPSDT is a program of pediatric and well child services for Medicaid HMO Program members, ages birth through the month of their twenty-first (21st) birthday. EPSDTs intent is to direct attention to the importance of preventive health services and early detection and treatment of problems identified during a well child visit.  The Contractor shall have written procedures for notification, tracking, and follow-up to ensure these services will be available to all eligible Medicaid HMO Program children and young adults.  The requirements for provision of EPSDT services are outlined in the Appendix C, Tab 1."  South Carolina Contract, page 15-16.

"EPSDT - An Early and Periodic Screening, Diagnosis and Treatment Program mandated by Title XIX of the Social Security Act." South Carolina Contract, page A3.

TX

"EPSDT means the federally mandated Early and Periodic Screening, Diagnosis and Treatment program contained at 42 USC 1396d(r)  (see definition for Texas Health Steps).  The name has been changed to Texas Health Steps (THSteps) in the State of Texas."  Texas Contract, page 7.

"Texas Health Steps (THSteps) is the name adopted by the State of Texas for the federally mandated Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.  It includes the State’s Comprehensive Care Program extension to EPSDT, which adds benefits to the federal EPSDT requirements contained in 42 United States Code §1396d(r), and defined and codified at 42 C.F.R. §440.40 and §§441.56-62.  TDH’s rules are contained in 25 TAC, Chapter 33 (relating to Early and Periodic Screening, Diagnosis and Treatment)."  Texas Contract, page 12.

UT

"ATTACHMENT B - Special Provisions
Article I - Definitions...
D.  'CHEC Program' or Child Health Evaluation and Care program in Utah's version of the federally mandated Early Periodic Screening, Diagnosis and Treatment (EPSDT) program as defined in 42 CFR Part 441, Subpart B..."  Utah Contract, Attachment B, page 1.

VA

"ARTICLE 1 - DEFINITIONS...
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) - Those services defined by Federal law in Section 1905(r) of the Social Security Act, 42 USC § 1396d (r), to include screening and diagnostic services to determine physical or mental defects in recipients under age twenty-one (21), and health care, treatment, and all other measures to correct or ameliorate any defects and chronic conditions discovered."  Virginia Contract, page 7.