Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-009 - Physician/Independent Lab/CRNA/ Radiation Therapy Center Provider Manual Update Transmittal #111; Nurse Practition Provider Manual Update Transmittal #65; Child Health Services (EPSDT) Provider Manual Update Transmittal #73

Current through Register Vol. 49, No. 6, June, 2024
Section II
Physician/Independent Lab/CRNA/Radiation Therapy Center
203.120
Physician's Role in the Child
			 Health Services (EPSDT) Program
The Child Health Services (EPSDT) program is a federally
				mandated child health component of Medicaid. It is designed to bring
				comprehensive health care to individuals eligible for medical assistance from
				birth up to their 21st birthday. The purpose of this program is to detect and
				treat health problems in the early stages and to provide preventive health
				care, including necessary immunizations. Child Health Services (EPSDT) combines
				case management and support services with screening, diagnostic and treatment
				services delivered on a periodic basis.
A. Early and periodic screening and diagnosis
			 and treatment (EPSDT) is a health care program designed for (1) health
			 evaluation as soon after birth as possible; (2) repeated at regular recommended
			 times; (3) to detect physical or developmental health problems and (4) health
			 care, treatment and other measures to correct or improve any defects and
			 chronic conditions discovered.
1. Screening
The Arkansas Medicaid Program requires that
all
eligible EPSDT participants under 21 years of age, must
				receive regularly scheduled examinations and evaluations of their general
				physical and mental health, growth, development and nutritional status.
These screenings must include, but are not limited to:
a. Comprehensive health and developmental
			 history.
b. Comprehensive unclothed
			 physical examination.
c.
			 Appropriate vision testing.
d.
			 Appropriate hearing testing.
e.
			 Appropriate laboratory tests.
f.
			 Dental screening services furnished by direct referral to a dentist for
			 children beginning at 3 years of age.
Screening services must be provided in accordance with
				reasonable standards of medical and dental practice, as soon as possible in a
				child's life and at intervals established for screening by medical, dental,
				visual and other health care experts.
An age appropriate screening may be performed when a
				child is being evaluated or treated for an acute or chronic
				condition.
The screening performed on the same date of service as an
				office visit for treatment of an acute or chronic condition may be billed as a
				periodic EPSDT screening, using the Form DMS-694.
View a DMS-694
				sample form.
Effective for dates of service on and after May 1, 2006,
				the office visit for treatment of an acute or chronic condition may be billed
				as a separate visit for the same date of service. The visit must be billed
				electronically, or on paper using form CMS-1500.
View a form
				CMS-1500 sample form.
The primary care physician may provide the screening or refer
				the child to a qualified Medicaid provider for screening. Primary care
				physician referral for ESPDT screening is mandatory in the 75 counties in
				Arkansas. See Section
				I of this
				manual.