EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents

6/2014

The Medicaid program’s benefit for children and adolescents is known as Early and Periodic Screening, Diagnostic and Treatment services, or EPSDT. EPSDT provides a comprehensive array of prevention, diagnostic, and treatment services for low-income infants, children and adolescents under age 21, as specified in Section 1905(r) of the Social Security Act (the Act). The EPSDT benefit is more robust than the Medicaid benefit for adults and is designed to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible. The goal of EPSDT is to assure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting.

Source: Centers for Medicare and Medicaid Services

Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/EPSDT_Coverage_Guide.pdf

Understanding the Interaction Between EPSDT and Federal Health Information Privacy and Confidentiality Laws

9/4/2013

This paper examines the federal and state law underpinnings of access to patient health records across health care providers and settings of care for Medicaid-enrolled children, who are entitled to Early and Periodic Screening Diagnostic and Treatment (EPSDT).  This analysis sets forth the relevant laws of the HIPAA Privacy Rule, the Family Educational Rights and Privacy Act (FERPA), and 42 C.F.R. Part 2, that affect the relationships of the health care professionals, minor children, and legal guardians as well as the relationships among health care, educational, and social services providers.  Finally, this paper provides examples of information exchange and management issues that may occur in the treatment of Medicaid-enrolled children.

Source: Health Information & the Law, the George Washington University’s Hirsch Law and Policy Program and the Robert Wood Johnson Foundation

Available at: http://www.healthinfolaw.org/article/understanding-interaction-between-epsdt-and-federal-health-information-privacy-and-confide-0