Common use of Early and Periodic Screening Clause in Contracts

Early and Periodic Screening. Diagnosis and Treatment (EPSDT) Services The federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, referred to as EPSDT/HealthWatch in Indiana, is a preventive healthcare program designed to improve the overall health of Medicaid and CHIP-eligible individuals from birth through the month of their 21st birthday. EPSDT/HealthWatch services are available for all Hoosier Care Connect members through the month of their 21st birthday. EPSDT/HealthWatch is a required component of Indiana Health Coverage Programs (IHCP) managed care and fee-for-service (FFS) programs for members who fall within the age range for EPSDT. Specific rules about EPSDT/HealthWatch services can be found in the IHCP Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch Provider Reference Module and the Indiana Administrative Code 405 IAC 5-15. The Contractor must provide all covered EPSDT services in accordance with 405 IAC 5-15-8. In covering well-child visits, the Contractor shall follow the latest standards from the American Academy of Pediatrics (AAP) Bright Futures Guidelines. In addition, EPSDT services include the provision of medically necessary services to members less than twenty-one (21) years old in institutions for mental disease (IMDs). The primary goal of EPSDT/HealthWatch is to ensure that children enrolled in IHCP receive age- appropriate comprehensive, preventive services. Early detection and treatment can reduce the risk of more costly treatment or hospitalization resulting from delayed treatment. See 405 IAC 5-15-8 and the IHCP Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch Provider Reference Module, provided in the Bidders’ Library, for details regarding components and recommended frequency of HealthWatch screenings. The Contractor shall educate pregnant women and work with providers to educate women about the importance of EPSDT screenings and encourage them to schedule preventive visits for their infants. Additionally, the Contractor shall ensure that members between the ages of nine (9) and twelve (12) months receive a blood lead screening test, and again at twenty-four (24) months of age. The Contractor shall also ensure that children who screen positive are enrolled in case management to ensure CDC recommended follow up and environmental investigation and management as indicated. If the member is at-risk for lead exposure, the initial screening should be performed at the 6-month visit and repeated at the 12-month and 24-month visits. Children between the ages of 36 months and 72 months of age must receive a blood lead screening if they have not been previously tested for lead poisoning. The Contractor will ensure that children with elevated blood lead levels are identified, their provider is notified and they receive the recommended follow-up treatment. The Contractor shall work with Indiana DCS to ensure that all Hoosier Care Connect wards and xxxxxx children receive appropriate EPSDT/HealthWatch services at each age level and in a timely manner. EXHIBIT 1 SCOPE OF WORK

Early and Periodic Screening. Diagnosis and Treatment (EPSDT) Services The federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, referred to as EPSDT/HealthWatch in Indiana, is a preventive healthcare program designed to improve the overall health of Medicaid and CHIP-eligible individuals from birth through the month of their 21st birthday. EPSDT/HealthWatch services are available for all Hoosier Care Connect members through the month of their 21st birthday. EPSDT/HealthWatch is a required component of Indiana Health Coverage Programs (IHCP) managed care and fee-for-service (FFS) programs for members who fall within the age range for EPSDT. Specific rules about EPSDT/HealthWatch services can be found in the IHCP Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch Provider Reference Module and the Indiana Administrative Code 405 IAC 5-15. The Contractor must provide all covered EPSDT services in accordance with 405 IAC 5-15-8. In covering well-child visits, the Contractor shall follow the latest standards from the American Academy of Pediatrics (AAP) Bright Futures Guidelines. In addition, EPSDT services include the provision of medically necessary services to members less than twenty-one (21) years old in institutions for mental disease (IMDs). The primary goal of EPSDT/HealthWatch is to ensure that children enrolled in IHCP receive age- appropriate comprehensive, preventive services. Early detection and treatment can reduce the risk of more costly treatment or hospitalization resulting from delayed treatment. See 405 IAC 5-15-8 and the IHCP Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch Provider Reference Module, provided in the Bidders’ Library, for details regarding components and recommended frequency of HealthWatch screenings. The Contractor shall educate pregnant women and work with providers to educate women about the importance of EPSDT screenings and encourage them to schedule preventive visits for their infants. Additionally, the Contractor shall ensure that members between the ages of nine (9) and twelve (12) months receive a blood lead screening test, and again at twenty-four (24) months of age. The Contractor shall also ensure that children who screen positive are enrolled in case management to ensure CDC recommended follow up and environmental investigation and management as indicated. If the member is at-risk for lead exposure, the initial screening should be performed at the 6-month visit and repeated at the 12-month and 24-month visits. Children between the ages of 36 months and 72 months of age must receive a blood lead screening if they have not been previously tested for lead poisoning. The Contractor will ensure that children with elevated blood lead levels are identified, their provider is notified and they receive the recommended follow-up treatment. The Contractor shall work with Indiana DCS to ensure that all Hoosier Care Connect wards and xxxxxx children receive appropriate EPSDT/HealthWatch services at each age level and in a timely manner. EXHIBIT 1 1.A. SCOPE OF WORK

Early and Periodic Screening. Diagnosis and Treatment (EPSDT) Services The federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, referred to as EPSDT/HealthWatch EPSDT in Indiana, is a preventive healthcare program designed to improve the overall health of Medicaid and CHIP-eligible individuals from birth through the month of their 21st birthday. EPSDT/HealthWatch EPSDT services are available for all Hoosier Care Connect members through the month of their 21st birthday. EPSDT/HealthWatch EPSDT is a required component of Indiana Health Coverage Programs (IHCP) managed care and fee-for-service (FFS) programs for members who fall within the age range for EPSDT. Specific rules about EPSDT/HealthWatch EPSDT services can be found in the IHCP Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch EPSDT) Provider Reference Module and the Indiana Administrative Code 405 IAC 5-15. The Contractor must provide all covered EPSDT services in accordance with 405 IAC 5-15-8. In covering well-child visits, the Contractor shall follow the latest standards from the American Academy of Pediatrics (AAP) Bright Futures Guidelines. In addition, EPSDT services include the provision of medically necessary services to members less than twenty-one (21) years old in institutions for mental disease (IMDs). All requests for EPSDT services not otherwise covered under the State Plan must be reviewed for medical necessity for eligible members. The primary goal of EPSDT/HealthWatch EPSDT is to ensure that children enrolled in IHCP receive age- appropriate comprehensive, preventive services. Early detection and treatment can reduce the risk of more costly treatment or hospitalization resulting from delayed treatment. Per 40 CFR 159.153, hospitalization means admission for treatment to a hospital, clinic, or other health care facility. Treatment as an out-patient is not considered to be hospitalization. See 405 IAC 5-15-8 and the IHCP Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch EPSDT) Provider Reference Module, provided in the Bidders’ Library, Module for details regarding components and recommended frequency of HealthWatch EPSDT screenings. The Contractor shall educate pregnant women and work with providers to educate women about the importance of EPSDT screenings and encourage them to schedule preventive visits for their infants. Additionally, the Contractor shall ensure that members between the ages of nine (9) and twelve (12) months receive a blood lead screening test, based on EPSDT guidelines and again at twenty-four (24) months of agein accordance with HEA 1313. The Contractor shall also ensure that children who screen positive are enrolled in case management to ensure CDC recommended follow up and environmental investigation and management as indicated. If the member is at-risk for lead exposure, the initial screening should be performed at the 6-month visit and repeated at the 12-month and 24-month visits. Children between the ages of 36 months and 72 months of age must receive a blood lead screening if they have not been previously tested for lead poisoning. The Contractor will ensure that children with elevated blood lead levels are identified, their provider is notified and they receive the recommended follow-up treatment. The Contractor shall work with Indiana DCS to ensure that all Hoosier Care Connect wards and xxxxxx children receive appropriate EPSDT/HealthWatch EPSDT services at each age level and in a timely manner. EXHIBIT 1 SCOPE OF WORK.