New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 308 - MANAGED CARE PROGRAM › Part 9 - BENEFIT PACKAGE › Section 8.308.9.15 - EARLY AND PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) SERVICES

Current through Register Vol. 35, No. 13, July 16, 2024
The benefit package includes the delivery of the federally
				  mandated EPSDT services ( 42 CFR Part 441 , Subpart B) provided by a primary
				  care provider (PCP) as detailed in 8.320.2 NMAC. The MCO shall provide access
				  to early intervention programs and services for a member identified in an EPSDT
				  screen as being at-risk for developing or having a severe emotional, behavioral
				  or neurobiological disorder. Unless otherwise specified in a service rule,
				  EPSDT services are for a member under 21 years of age. For detailed description
				  of each service, see 8.320.2 NMAC. EPSDT behavioral health services are
				  included in
				  8.308.9.19
				  NMAC.
A.
EPSDT nutritional
				counseling and services:
The benefit package includes nutritional
				services furnished to a pregnant member and a member under 21 years of age as
				detailed in 8.310.2 NMAC.
B.
EPSDT personal care:
The benefit package includes personal care
				services for a member.
C.
EPSDT private duty nursing:
The benefit package includes private
				duty nursing for a member and the services shall be delivered in either his or
				her home or school setting.
D.
EPSDT rehabilitation services:
A member under 21 years of age who
				is eligible for home and community based waiver services receives medically
				necessary rehabilitation services through the EPSDT program; see 8.320.2 NMAC
				for a detailed description. The home and community-based waiver program
				provides rehabilitation services only for the purpose of community
				integration.
E.
Services
				provided in schools:
The benefit package includes services to a member
				provided in a school, excluding those specified in their individual education
				plan (IEP) or the individualized family service plan (IFSP); see 8.320.6
				NMAC.
F.
Tot-to-teen health
				checks:
(1) The MCO shall adhere to the
				MAD periodicity schedule and ensure that each eligible member receives
				age-appropriate EPSDT screens (tot-to-teen health checks), referrals, and
				appropriate services and follow-up care. See 8.320.2 NMAC for detailed
				description of the benefits. The services include, but are not limited to:
(a) education of and outreach to a member or
				the member's family regarding the importance of regular screens and health
				checks;
(b) development of a
				proactive approach to ensure that the member receives the services;
(c) facilitation of appropriate coordination
				with school-based providers;
(d)
				development of a systematic communication process with MCO network providers
				regarding screens and treatment coordination;
(e) processes to document, measure and assure
				compliance with MAD's periodicity schedule; and
(f) development of a proactive process to
				insure the appropriate follow-up evaluation, referral and treatment, including
				early intervention for developmental delay, vision and hearing screening,
				dental examinations and immunizations.