Source: https://healthlaw.org/resource/fact-sheet-nc-health-check/
Timestamp: 2019-04-26 13:47:24+00:00

Document:
This fact sheet provides an overview of EPSDT in North Carolina.
Screens, or well-child check ups, are a basic element of the EPSDT program. As noted above, four separate types of screens are required: medical, vision, hearing, and dental.
2. Vision, Hearing and Dental Services.
The policy instruction has been posted on the DMA and Division of Mental Health (DMH) websites. It instructs DMA and DMH to regularly inform staff, other divisions, contractors, agents, Medicaid providers, families and other agencies working with children and adolescents covered by Medicaid. Moreover, “all affected staff will receive training on EPSDT policy and procedures.” (19) The instructions are posted in several places on DMA and DMH’s websites.
1. Family and Children’s Medicaid MA-3540.XXXIX; DMA, “Policy Instructions: Early and Periodic Screening, Diagnosis and Treatment Services (“EPSDT Policy”),” (Jan. 28, 2005), www.ncdhhs.gov/dma/epsdt_policy.pdf; 42 U.S.C. §§ 1396a(a)(43), 1396a(a)(10)(A), 1396d(a), 1396d(r).
4. DMA, “Health Check Program,” http://www.dhhs.state.nc.us/dma/healthcheck.htm. See generally Family and Children’s Medicaid MA-3540.XXXIX.
http://www.dhhs.state.nc.us/DMA/bulletin/HealthCheck0405.pdf See also H.R. REP. NO. 101-247, at 399 (Sept. 20, 1989), reprinted at 1989 U.S.C.C.A.N. 1906, 2125. See also CMS,STATE MEDICAID MANUAL § 5240.
8. DMA EPSDT Bulletin, p. 3.
9. See 42 U.S.C. § 1396d(r)(2).
10. See Id. at § 1396d(r)(4).
11. See Id. at § 1396d(r)(3).
12. See CMS,STATE MEDICAID MANUAL § 5123.G.
13. DMA, “Early Periodic Screening, Diagnosis and Treatment (EPSDT) and Health Check: Complete Check-Ups and Treatment for Children,” p. 2 (stating that recommended visit schedule is only a guideline and “if your child needs to have exams on a different schedule, the visits are still covered.”), See also, e.g., Memorandum from Director, Health Care Financing Administration Medicaid Bureau, to Region III Administrator, Health Care Financing Administration (Apr. 12, 1991) (available from National Health Law Program, Chapel Hill, NC). This is significant because the interperiodic visit qualifies the child for EPSDT’s treatment benefits, described infra.
14. 42 U.S.C. § 1396d(r)(5). For cases applying EPSDT’s treatment mandate, see Pereira v. Kozlowski, 996 F. 2d 723 (4th Cir. 1993), affg 805 F. Supp. 361 (E.D. Va.1992) (ordering coverage of organ transplant).
15. DMA, EPSDT Policy, p. 2, note 33, supra.
16. DMA EPSDT Policy, p. 3, note 33, supra. See also 42 U.S.C. § 1396a(a)(43)(C).
17. DMA EPSDT Policy, pp. 1, 2, note 33, supra.
20. See 42 U.S.C. § 1396a(a)(43)(A) (1998). Congress has said states need to take “aggressive action” to inform children and families about EPSDT. See 135 CONG. REC. S 13234 (Oct. 12, 1989).
21. CMS, State Medicaid Manual §§ 5121, 5150.
This document contains EPSDT guidance from the NC Divisions of Medical Assistance.

References: § 5240
 § 1396
 § 1396
 § 1396
 § 5123
 § 1396
 v. 
 § 1396
 § 1396