EPSDT Services: Recordkeeping Requirements

(A) Medical Records. (1) A provider must create and maintain a record for every member receiving EPSDT services, in accordance with MassHealth regulations governing medical records at 130 CMR 450.205. (2) In addition, the medical record for each member receiving EPSDT services must contain documentation of the screening procedures listed in Appendix W: EPSDT Services: Medical and Dental Protocols and Periodicity Schedules as well as the following: (a) the results of all laboratory tests; (b) the name of each referral provider; and (c) the results of any component of the Medical Schedule that was delivered by another provider. (B) Determination of Compliance with Medical Standards. The MassHealth agency may review the medical records of members receiving EPSDT services to determine the necessity and quality of the medical services provided. Any such determinations will be made in accordance with 130 CMR 450.204 and 130 CMR 450.206.