Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-037 - Physician/Independent Lab/CRNA/Radiation Therapy Center Provider Manual Update Transmittal #127

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Physician/Independent Lab/CRNA/Radiation Therapy Center
TOC required
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, Diagnosis
			 and Treatment (EPSDT) is a preventive health care program designed for:
(1) newborn health evaluations as soon after
			 birth as possible;
(2) routine,
			 timely childhood immunizations;
(3) regular screenings to detect physical or
			 developmental health problems and
(4)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 age 21 receive regularly
				scheduled examinations and evaluations of their general physical and mental
				health, growth, development and nutritional status.
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 by the American Academy of
				Pediatrics.
An age appropriate screening may be performed when a child is
				being evaluated or treated for an acute or chronic condition.
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.
2. Diagnosis
Diagnosis is the determination of the nature or cause of
				physical or mental disease or abnormality through the combined use of health
				history, physical, developmental and psychological examination, laboratory
				tests and X-rays.
3.
			 Treatment
Treatment means physician, hearing, visual services, or dental
				services and any other type of medical care and services recognized under State
				law to prevent or correct disease or abnormalities detected by screening or by
				diagnostic procedures.
Physicians and other health professionals who provide Child
				Health Services (EPSDT) screening may diagnose and treat health problems
				discovered during the screening or may refer the child to other appropriate
				sources for treatment.
				I f immunization is recommended
				at the time of screening, immunization(s) should be provided at that time
				.
When a condition is diagnosed through a Child Health Services
				(EPSDT) screen and requires treatment services not normally covered under the
				Arkansas Medicaid Program, those treatment services will be considered for
				reimbursement if the service is medically necessary and permitted under federal
				Medicaid regulations. The PCP must request consideration for reimbursement
				using the EPSDT Prescription/Referral for Medically Necessary Services/Items
				Not Specifically Included in the Medicaid State Plan Form DMS-693.
View or print form DMS-693
.
Refer to Section I of this manual
(Services
				Available through the Child Health Services (EPSDT) Program
) for
				additional information.