| EPSDT
Data Requirements and Opportunities |
|
State
Medicaid agencies are required to report annually
on EPSDT services (submitted on the 416 form)
The annual report provides basic information
on the number of children (by age and basis
of Medicaid eligibility) who receive medical
or dental screens and the number referred for
diagnostic or treatment services. |
| For
the overall program, states have opportunities
to: |
- Determine
the number of screens due according to the
periodicity schedule and rate of EPSDT screens
- Assess
the percentage of children with health problems
identified through screen or diagnostic tests
for whom treatment was initiated (paid for
by Medicaid)
-
Conduct record reviews/audits.
-
Track pediatric providers’ billing for
screens.
-
Monitor provider participation and utilization
patterns.
|
| In
Medicaid managed care, states have opportunities
to: |
- Require
managed care organizations (MCOs) to submit
encounter data for EPSDT screening.
-
Link databases, such as immunization registries,
lead screening databases, and Head Start EPSDT
data sets.
-
Use data to monitor performance of MCOs as
part of a quality improvement/feedback loop.
-
Disseminate MCO performance data to serve
as an incentive to report complete and accurate
data.
|
| EPSDT
Data Reporting in the Pediatric Purchasing Specifications
Top
|
|
GWU Medicaid Pediatric Purchasing Specifications
(MEDIPED)
provide illustrative language on EPSDT and serve
as the "base" for GWU’s other
child-related purchasing specifications. The
list below shows sample contract language regarding
EPSDT data, as well as the other data topics
covered.
§902.
EPSDT Data
|
-
Annual Participation Report --Contractor shall
collect and report, in such form and manner
as Purchaser specifies, the data required
to enable Purchaser to comply with the requirements
of §1902(a)(43)(D) of the Social Security
Act, 42 U.S.C. §1396a(a)(43)(D), as implemented
by State Medicaid Manual, HCFA Pub. 45-2,
Transmittal No. 86 (May, 1996) (HCFA-416 Annual
Report), relating to participation by enrolled
children in early and periodic screening,
diagnostic, and treatment (EPSDT) services.
- Compliance
with EPSDT Requirements -- Contractor shall
collect and report, in such form and manner
as Purchaser specifies, data relating to Contractor's
compliance with the requirements of §102
of Part 1[of MEDIPED] relating to the furnishing
of EPSDT services to enrolled children.
§903.
Public Health Data
§904.
Access Data
§905.
Quality Data
§906.
Aggregate Utilization Data
§907.
Encounter Data
§908.
Complaint and Grievance Data
§909.
Expenditure and Claims Data
§910.
Data Relating to Practitioners
§911.
Confidentiality of Data "
|
| EPSDT
Data Links to More Information Top |
|
Federal
Statistics |
|
| Private
Organizations |
| |
| State
Examples |
|
| Other
Information on EPSDT Data and Monitoring |
| |
