Section III EPSDT A Comprehensive Child Health Program 1 712010 EPSDT 712010 2 E Early P Periodic S Screening D Diagnosis T Treatment EPSDT 3 EPSDT is a Federal requirement outlined in the State Medicaid Manual published by the Centers for Medicare and Medicaid Services ID: 317698
Download Presentation The PPT/PDF document "CHDP Director/Deputy Director Training" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
CHDP Director/Deputy Director Training Section III
EPSDT: A Comprehensive Child Health Program
1
7/1/2010Slide2
EPSDT
7/1/2010
2
E Early
P Periodic
S Screening
D Diagnosis
T TreatmentSlide3
EPSDT
3
EPSDT is a Federal requirement outlined in the State Medicaid Manual published by the Centers for Medicare and Medicaid Services.EPSDT Regulations provide the framework for the CHDP Program. Deputy Directors should be familiar with EPSDT Regulations.
Access CMS Publication #45 State Medicaid Manual
http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?itemID=CMS021927
for the complete text.
7/1/2010Slide4
California’s Implementation of EPSDT
4
7/1/2010Slide5
California Implementing EPSDT
5
States have flexibility on how they implement the Federal EPSDT Program.CHDP is how California meets the EPS portion of the EPSDT requirements.The guiding document for CHDP is part of California Code of Regulations Title 17.
Access Title 17 from the CHDP Home page under Program Overview.
7/1/2010Slide6
Informing
6
The responsibilities for “Informing Families” are set in written format and agreed upon by CHDP, Department of Social Services and Probation in the CHDP Interagency Agreement (IAA).“Informing Families” is comprised of both basic informing and intensive informing activities. Basic informing is carried out by Social Services and Probation staff. Intensive informing is conducted by CHDP staff.
An IAA model format is available in the Plan and Fiscal Guidelines (PFG).
7/1/2010Slide7
Basic Informing
7
7/1/2010Slide8
Basic Informing
8
To Whom?
All CalWorks & Medi-Cal eligible families with children under 21 years
Newly eligible
Upon renewal (annual)
Those who have not used EPSDT services for at least one year
Children in foster care with federally funded benefits
Medi-Cal eligible pregnant women
7/1/2010Slide9
Basic Informing
9
How?Face-to-face, oral and written methodsCHDP Information Brochure*Clear, non-technical, understandable information
Must include means to communicate with those who are deaf, blind, illiterate or
not able to read or understand the English language
*
Any revision to the content of the CHDP Information Brochure must be approved by the State.
7/1/2010Slide10
Basic Informing
10
About What?Benefits of preventive health and dental careWhat health and dental services are offered
Periodicity schedule summary
Ability to receive initial and periodic health and dental exams per the periodicity schedule
Treatment is provided for problems detected during screening
7/1/2010Slide11
Basic Informing
11
How to obtain medical and dental servicesHow to get contact information for CHDP providers
Declined services at time of informing can be requested at later time as long as Medi-Cal eligible
Able
to go to CHDP provider of choice; if full range of CHDP services not offered by provider, can receive balance of services, along with scheduling and transportation assistance upon request to CHDP program or welfare department
7/1/2010
11Slide12
Basic Informing
12
Assistance in referral shall be provided
Transportation assistance provided if requested
Scheduling assistance provided if requested
CHDP services from approved providers are at no cost
7/1/2010
12Slide13
The CHDP Referral (PM 357)
13
7/1/2010Slide14
The CHDP Referral (PM 357)
14
The Eligibility Worker, Probation Officer, or Social Worker is required to ask whether the client:Wants more information about CHDPWants CHDP medical or dental servicesNeeds scheduling or transportation assistance to obtain CHDP medical and/or dental services
Any with “Yes” responses must be sent to the CHDP Program on a CHDP Referral (PM 357) for intensive informing
7/1/2010Slide15
Intensive Informing
15
7/1/2010Slide16
Intensive Informing
16
About What?The value of preventive health services
The availability of CHDP health assessments
The need for prompt diagnosis and treatment of suspected disabilities
The nature, scope, and benefits of CHDP
Assistance with scheduling and transportation if requested
7/1/2010Slide17
Intensive Informing
17
How?
CHDP or HCPCFC staff use a combination of methods:
telephone, home visit, face-to-face, office visit, or letter.
A good faith effort will be made to locate all persons lost to contact and includes query of the local welfare department for current address, telephone number, and Medi-Cal status.
(Reference: Joint Social Services/CHDP Responsibilities section of the CHDP IAA model format in PFG)
Document the contact efforts!
7/1/2010Slide18
Intensive Informing
18
To Whom?Those requesting more information
Those requesting assistance with scheduling and transportation to medical and/or dental appointments
CHDP follow-up of referrals must be documented.
7/1/2010Slide19
Sample PM 357 #1Below is an example of the portion of a PM 357 of a client requesting additional information.
7/1/2010
19Slide20
Sample PM 357 #2Below is an example of the portion of a PM 357 of a client requesting assistance with scheduling of a medical appointment.
7/1/2010
20Slide21
Required Documentation
21
Contact efforts: method, date, name of person contactedType of assistance givenDate(s) of appointments and name of provider(s)
Confirmation of CHDP medical and/or dental services may be obtained from family, provider, or PM 160
7/1/2010Slide22
Goal of Informing Activities
22
Outreach and Health Education services shall bedesigned to ensure that the only reason eligible
persons do not participate in the health assessment
and referral for diagnosis and treatment portions of the program is because:
They intelligently and knowingly decline such participation for reasons unrelated to availability and accessibility of the health assessment, diagnosis and treatment services.
7/1/2010Slide23
Deputy Director’s Responsibilities
23
7/1/2010Slide24
Deputy Director’s Responsibilities
24
Assure that timely basic informing training occurs Eligibility Workers, Child Welfare Social Workers & Probation Officers must receive basic informing orientation within 90 days of employment and annually
Orientation includes:
Description of CHDP
Available services
Legal mandate to provide basic informing
How to provide basic informing
How to fill out the PM357 and where to send it
7/1/2010Slide25
Deputy Director’s Responsibilities
25
Assure any diagnostic and treatment services are initiated within 120 days of eligibility determination.Assure documentation of Intensive Informing efforts is complete.Maintain data required for annual reporting
(
CHDP Program Referral Data Form
in current PFG).
Retain records for three years in addition to current year.
7/1/2010Slide26
Resources
26
CMS Publication #45 State Medicaid Manual http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?itemID=CMS021927 California Code of Regulations Title 17
(link available from CHDP Home page, Program Overview)
CHDP Information Brochure
(online at CHDP Homepage)
CHDP Program Letter 81-5
County CHDP Interagency Agreement
CMS Plan & Fiscal Guidelines Section 4
7/1/2010