MAY2002

What is the Early and Periodic Screening Diagnosis and Treatment Program, and what are its implications for the Grant Communities?

The Early and Periodic Screening Diagnosis and Treatment Program (EPSDT) is a part of the Medicaid program. The Medicaid program (Title XIX of the Social Security Act) was enacted in 1965 and amended to include the Early and Periodic Screening Diagnosis and Treatment program two years later. The Medicaid program is designed to be a partnership between the Federal Government and the States. The main purpose of the Medicaid program is to serve as health insurance for individuals and families who are poor and near poor. Therefore, Medicaid reimburses health care (including mental health) professionals for services provided to individuals who are enrolled in its program. The main purpose of the EPSDT program is to ensure the provision of preventive health services that include but are not limited to:

• A complete health history and physical examination,

• A developmental assessment,

• A behavioral health assessment,

• Immunizations,

• Vision and hearing screening,

• A dental examination and treatment by a dentist,

• Laboratory tests appropriate to the child/adolescent's age and needs

• All follow-up services that are necessary to diagnose and treat the child/adolescent regardless of any limitations as to the number and type of services the State may have imposed. This includes mental health services.

• "Case/Care-Management" to ensure that children and adolescents receive all services in a timely and comprehensive fashion.

A number of states have utilized the EPSDT program to greatly expand mental health and case-management services. The health professionals who perform these services, including making referrals to appropriate specialists, are primary care providers. Primary care providers for children and adolescents are:

• Pediatricians,

• Family Practitioners,

• Pediatric and Family Nurse Practitioners,

• Physician Assistants who are under the immediate supervision of a physician, and

• Internists for adolescents and/or young adults over the age of 18 years.

 Therefore, it is extremely important for the grant community to join in partnership with primary care professionals, as individuals and with their organizations, to assure the delivery of these services.