23 Miss. Code. R. 223-1.5

Current through December 10, 2024

Rule 23-223-1.5 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Screenings

A. An initial or established age-appropriate medical screening which must include at a minimum:

1. A comprehensive health and developmental history including assessment of both physical and mental health development and family history,

2. A comprehensive unclothed physical examination,

3. Appropriate immunizations according to the Advisory Committee on Immunization Practices (ACIP), and specific to age and health history,

4. Laboratory tests adhering to the AAP Bright Futures Periodicity Schedule,

5. Sexual development and sexuality screening adhering to the AAP Bright Futures Periodicity Schedule, and

6. Health education, including anticipatory guidance.

B. Developmental screening or surveillance to include diagnosis with referral to an enrolled Mississippi Medicaid provider for diagnosis and treatment for defects discovered.

C. Psychosocial/behavioral assessment to include diagnosis with referral to an enrolled Mississippi Medicaid provider for diagnosis and treatment for defects discovered.

D. Vision screening, at a minimum, to include diagnosis with referral to an enrolled Mississippi Medicaid optometry or ophthalmology provider for diagnosis and treatment for defects discovered.

E. Hearing screening, at a minimum, to include diagnosis with referral to an enrolled Mississippi Medicaid audiologist, otologist, otolaryngologist or other physician hearing specialists for diagnosis and treatment for defects discovered.

F. Dental screening, at a minimum, to include diagnosis with referral to an enrolled Mississippi Medicaid dental provider for beneficiaries at eruption of the first tooth or twelve (12) months of age for diagnosis and referral to a dentist for treatment and relief of pain and infections, restoration of teeth and maintenance of dental health.

G. Maternal depression screening, to include a referral:

1. To an enrolled Medicaid provider if the mother is eligible for Medicaid, or

2. To other healthcare providers as medically indicated including, but not limited to:

a) Federally Qualified Health Center (FQHC),

b) Rural Health Clinic (RHC), or

c) Community Mental Health Center (CMHC).

H. The Division of Medicaid covers off-site screening at the following locations:

1. School,

2. Day care center, or

3. Head start center.

I. Off-site Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) screening providers must:

1. Provide off-site screenings only within the county or within forty (40) miles of the county where the physician's office is located,

2. Develop and adhere to confidentiality policies that are approved by the Division of Medicaid.

3. Ensure medical personnel performing the physical examination are limited to Mississippi Medicaid enrolled physicians, nurse practitioners or a physician assistants employed by the physician's office.

4. Complete all age-appropriate components of the EPSDT screening during one (1) visit or encounter.

5. Have a designated well-lit private room to perform the screening assessments which must be in close proximity to:

a) Hot and cold running water, and

b) A bathroom.

6. Obtain written parental/guardian consent:

a) The written consent must contain the following statements:

1) Parent/guardian right to be present during EPSDT screenings,

2) The physical examination will be unclothed,

3) The EPSDT screenings take the place of the yearly wellness exam performed at the beneficiary's primary care provider's office, and

4) Vaccines will be administered, if applicable,

b) Must include a space for the parent/guardian signature and date giving approval for the EPSDT screenings to be performed, and

c) Must be received within sixty (60) days prior to the EPSDT screenings.

7. Encourage the parent/guardian to be present during the EPSDT screenings,

8. Follow-up with the parent/guardian on the results of the screening by mail or in a one-on-one meeting.

9. Utilize the anticipatory guidance materials that are:

a) Age appropriate,

b) Mailed to the parent/guardian for beneficiaries under the age of fourteen (14).

c) Given to beneficiaries fourteen (14) years of age and above.

J. The Division of Medicaid does not reimburse for services other than EPSDT screenings in an off-site location.

23 Miss. Code. R. 223-1.5

42 U.S.C. § 1396d; 42 C.F.R Part 441, Subpart B; Miss. Code Ann. §§ 43-13-117, 4313-121.

Revised to correspond with SPA 2015-017 (eff. 11/01/2015)

Amended 10/1/2016

Amended 12/1/2018

Amended 11/1/2020

Amended 8/1/2021