Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 450.000 - Administrative and Billing Regulations › Section 450.141 - EPSDT Services: Definitions

Current through Register 1525, July 5, 2024
Dental Care
- dental services
				customarily furnished by or through dental providers as defined in
				130 CMR
				420.000:
Dental Services
, to the
				extent the furnishing of those services is authorized by the MassHealth
				agency.
EPSDT Dental Protocol and Periodicity Schedule (the
				Dental Schedule)
- a schedule (
see
Appendix W:
EPSDT Services: Medical and Dental Protocols and Periodicity
				Schedules
of all MassHealth provider manuals) developed and
				periodically updated by the MassHealth agency in consultation with recognized
				medical and dental organizations involved in child health care. The Dental
				Schedule consists of screening and treatment procedures arranged according to
				the intervals or age levels at which each procedure is to be provided.
EPSDT Medical Protocol and Periodicity Schedule
				(the Medical Schedule)
- a schedule (
see
Appendix
				W:
EPSDT Services: Medical and Dental Protocols and Periodicity
				Schedules
of all MassHealth provider manuals) developed and
				periodically updated by the MassHealth agency in consultation with recognized
				medical and dental organizations involved in child health care. The Medical
				Schedule consists of screening procedures arranged according to the intervals
				or age levels at which each procedure is to be provided.
Interperiodic Visit
- the provision of
				screening procedures or treatment services at an age other than those indicated
				on the Medical or the Dental Schedule. Interperiodic visits may be:
(1) screenings that are medically necessary
			 to determine the existence of a suspected illness or condition, or a change in
			 or complication of a preexisting condition;
(2) the provision of the full-range of EPSDT
			 screening or treatment services delivered at an age other than one listed on
			 the Medical or Dental Schedule to update the member's care according to the
			 Medical or Dental Schedule; or
(3)
			 additional screening or treatment services provided to a member whose care is
			 already up-to-date according to the Medical or Dental Schedule.
Periodic Visit
- the provision of
				screening procedures appropriate to the member's age and medical history, as
				prescribed by the Medical Schedule or the Dental Schedule.
Primary Care
- health care services
				customarily furnished by or through a general practitioner, family physician,
				internal medicine physician, obstetrician/gynecologist, pediatrician, certified
				nurse practitioner, certified nurse midwife, or physician assistant to the
				extent the furnishing of those services is legally authorized in the
				Commonwealth. Primary care does not include emergency or post stabilization
				services provided in a hospital or other setting.
Primary Care Providers
- a general
				practitioner, family physician, internal medicine physician,
				obstetrician/gynecologist, pediatrician, certified nurse practitioner,
				certified nurse midwife, or physician assistant.