Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 25 - Physician Program › Section 13 CSR 70-25.110 - Payment for Early Periodic Screening, Diagnostic, and Treatment Program Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates language and removes
				  an obsolete statutory reference.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
(1) The Department of Social Services shall
				administer an Early Periodic Screening, Diagnostic, and Treatment (EPSDT)
				Program. In Missouri the EPSDT Program is administered as the Healthy Children
				and Youth (HCY) Program. The EPSDT/HCY Program provides comprehensive and
				preventive health care services for MO HealthNet-eligible persons under
				twenty-one (21) years of age including those in the legal custody of the
				Department of Social Services or any division of the department at no cost to
				the child or to the parents or guardians if they accept the offer of this
				service. The services covered and not covered, the limitations under which
				services are covered, and the maximum allowable fees for all covered services
				shall be determined by the division and shall be included in the MO HealthNet
				provider manuals, which are incorporated by reference and made a part of this
				rule as published by the Department of Social Services, MO HealthNet Division,
				615 Howerton Court, Jefferson City, MO 65109, at its website
				http://manuals.momed.com/manuals, November 25, 2020. This rule does not
				incorporate any subsequent amendments or additions.
(2) The EPSDT Program shall make a general
				physical examination available to eligible participants. The components of the
				general physical examination shall include a comprehensive health and
				developmental history, a comprehensive unclothed physical examination,
				appropriate immunizations, laboratory tests, health education, a vision screen,
				a dental screen, and hearing services. These screens will be made available at
				the frequency recommended by Bright Futures/American Academy of Pediatrics and
				the American Academy of Pediatric Dentists.
(A) Interperiodic screenings outside the
				recommendations of Bright Futures/American Academy of Pediatrics or the
				American Academy of Pediatric Dentists are available when medically
				indicated.
(B) Partial screens for
				vision, hearing, dental, unclothed physical examination, an interval history,
				appropriate laboratory tests, immunizations, developmental/mental health
				assessment, and anticipatory guidance shall be reimbursable services.