Title
V Rules for EPSDT Linkages |
This
page provides an overview of the relationship
between Title V and Medicaid, including the
EPSDT program, with a focus on federal law requirements.
Title V of the Social Security Act was enacted
in 1935 as a health services safety net for
all women and children. Today, the Title V Maternal
and Child Health Services Block Grant continues
to pursue the goal of improving the health of
all mothers and children. Title V is administered
by the Health Resources and Services Administration
(HRSA).
Between 1967 and 1989, Congress enacted a number
of amendments to Title V, adding requirements
to work closely with and assist Medicaid in
a number of activities. Currently, the Title
V law requires that state MCH programs:
|
- Assist
with coordination of EPSDT. View
details
-
Establish coordination agreements for with
their State Medicaid programs. View
details
-
Provide a toll-free number for families seeking
Title V or Medicaid providers.
-
Provide outreach and facilitate enrollment
of Medicaid eligible children and pregnant
women. View details
-
Share data collection responsibilities, particularly
related to infant mortality details
and Medicaid. View
details
-
Provide services for children with special
health care needs and disabilities not covered
by Medicaid. View
details
|
EPSDT
- Title V Requirements Top |
Federal
EPSDT rules call for coordination with Title
V, but in different ways than the Title V law
requires coordination with Medicaid.
Federal EPSDT Requirements include: |
- Establishment
of written state MCH-Medicaid agreements which
provide for maximum utilization of Title V-supported
services and aims to improve child health
status.
- Reimbursement
of Title V providers for services rendered,
even if such services are provided free of
charge to low-income uninsured families. (Payment
mechanisms include reimbursement for costs,
capitation payments, or prospective interagency
transfers with retrospective adjustments.)
Learn
more about the role of Title V agencies in administering
EPSDT programs.
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State
Strategies for Using Title V to Strengthen Medicaid’s
EPSDT Program Top
|
This
page provides examples of how the states have
used relationships between Title V and Medicaid,
including the EPSDT program, to improve child
health. Over the years, states have: |
- Assisted
with administration of EPSDT.
- Provided
EPSDT screening through Title V funded child
health clinics operated by local health departments.
- Created
toll-free hotlines to assist families with
information about and enrollment in Medicaid
and EPSDT.
- Fund
local health departments to provide outreach,
coordination, and referral services. Used
home visiting programs as a strategy for EPSDT
outreach and informing.
-
Recruited, trained, and supported public and
private EPSDT providers, including through
“medical home” initiatives.
-
Funded centers of excellence and regional
centers for specialty pediatric care, including
child development, genetic services, orthopedic
care, sickle cell disease treatment, and HIV/AIDS.
-
Promoted use of EPSDT financing for school-based
health centers in medically under-served communities,
as well as other school health initiatives.
- Assisted
in development of EPSDT screening tools and
periodicity schedules.
- Developed
standards of care and policies to support
quality improvement in EPSDT, including development
of managed care contract provisions.
-
Promoted dental screening and preventive oral
health services (e.g., fluoride rinsing, dental
sealants) in pediatric care settings.
-
Evaluated and/or monitored EPSDT program performance.
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Title
V Role in Quality Monitoring Top |
State
Title V agencies can play an important role
in monitoring EPSDT. The examples below describe
some current and past data and monitoring activities
undertaken by Title V agencies. |
Tracking
Participation |
|
Provider
Related Activities |
- Collaborate
with the Academy of Pediatrics, Academy of
Family Physicians, Primary Care Association,
and other professional organizations to train
about and promote participation in EPSDT
- Develop
EPSDT data collection tools for maternity
and pediatric providers
- Monitor
EPSDT screening rates among local health departments
that provide well-child care
|
Activities
Related to Managed Care |
- Assist
in conducting managed care record review or
focus studies
- Monitor
the adequacy of screens
|
Title
V - EPSDT Partnerships to Improve EPSDT Administration
Top |
State
Title V agencies can play an important role
in guiding EPSDT. In fact, the EPSDT rules encourage
state Medicaid agencies to delegate tasks to
Title V agencies to assure access and receipt
of the full range of screening, diagnostic,
and treatment services.* Such delegation may
be local, regional, or statewide. The examples
below describe some specific activities undertaken
by Title V agencies. |
Family
Support Activities |
- Develop
and implement outreach initiatives
-
Assist with eligibility and enrollment
- Coordinate
service delivery for children with special
health care needs enrolled in Medicaid
|
Provider
Related Activities |
- Recruit
and train providers
- Develop
clinical guidance for providers based on Bright
Futures and EPSDT rule
- Oversee
EPSDT screening in local health departments,
including data collection to monitor screening
rates
- Help
assure continuing of care through care coordination
projects
|
Activities
Related to Managed Care |
- Assist
in developing managed care contract provisions
-
Monitor the adequacy of managed care plan
provider networks
|
Other
Administrative Activities |
- Develop
standards of care and periodicity schedules
-
Convene expert panels and medical advisory
boards
Review medical necessity decisions using skilled
medical personnel with expertise in maternity
and pediatric care
|
*
Note - EPSDT rules state that: “Federal
financial participation (FFP) is available to
cover the costs to public agencies of providing
direct support to the Medicaid agency in administering
the EPSDT program.” Generally, the administrative
matching rate of 50% is used. |