Epsdt Medical Necessity Standard

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Early and Periodic Screening, Diagnostic, and Treatment

https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html

Early and Periodic Screening, Diagnostic, and Treatment. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in …

Considerations in the Determination of Medical …

https://publications.aap.org/pediatrics/article/150/3/e2022058882/188901/Considerations-in-the-Determination-of-Medical

Medicaid adopted the EPSDT standards as a mandatory component in their statutory pediatric scope of benefits (42 CFR §441.50-441.62 [1985]). 3,18 The preventive …

EPSDT in Medicaid : MACPAC

https://www.macpac.gov/subtopic/epsdt-in-medicaid/

Diagnosis and treatment of medical conditions. The state must ensure timely initiation of treatment in accordance with reasonable standards of medical and dental practice, …

EPSDT - Medi-Cal

https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/epsdt.pdf

The standards to meet medical necessity differ between Medi-Cal and EPSDT. The EPSDT standard is as follows: EPSDT services are medically necessary or a medical …

EPSDT - A Guide for States - HHS.gov

https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/epsdt_coverage_guide_11.pdf

EPSDT’s screening requirements, including when interperiodic screening should be provided; Scope of services covered under EPSDT; EPSDT’s requirements governing …

State Definitions of Medical Necessity under the Medicaid EPSDT …

https://nashp.org/state-definitions-of-medical-necessity-under-the-medicaid-epsdt-benefit/

State Administrative code 560-x-11-.14 defines medical necessity for EPSDT services as follows: The state requires that Medicaid covers medically necessary services …

EPSDT: Medicaid’s Critical But Controversial Benefits …

https://www.ncbi.nlm.nih.gov/books/NBK560010/

EPSDT: Medicaid’s Critical But Controversial Benefits Program for Children Medicaid is the largest program in the federal “safety net” of public assistance programs, …

State Definitions of Medical Necessity Under the Medicaid …

https://ciswh.org/resources/state-definitions-of-medical-necessity-under-the-medicaid-epsdt-benefit/

Federal law requires states to cover “medically necessary services” under the EPSDT benefit “whether or not such services are covered under the State plan.” The federal …

Department of Health Care Services - California

https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2019/APL19-010.pdf

Pursuant to WIC Section 14059.5(b)(1), for individuals under 21 years of age, a service is considered “medically necessary” or a “medical necessity” if the service …

1991-EPSDT-Medical-Necessity | Guidance Portal

https://www.hhs.gov/guidance/document/1991-epsdt-medical-necessity

1991-EPSDT-Medical-Necessity Guidance for: This letter provides clarification on Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) …

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