Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Provider

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Provider Participation Requirements A. Enrolled Mississippi Medicaid providers who have signed an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) specific provider agreement must conduct periodic screenings and medically necessary interperiodic visits for all EPSDT-eligible beneficiaries in accordance with the EPSDT Periodicity Schedule as recommended by the American Academy of Pediatrics (AAP) Bright Futures Periodicity Schedule and must provide or refer EPSDT- eligible beneficiaries with an identified need for additional assessment, diagnosis, and/or treatment services to an appropriate provider. B. Dental providers must provide services to all EPSDT-eligible beneficiaries in accordance with the dental schedule of the American Academy of Pediatric Dentistry (AAPD) and in accordance with AAP guidelines. Dental providers must provide or refer EPSDT-eligible beneficiaries with an identified need for additional assessment, diagnosis, and/or treatment services to an appropriate provider. C. EPSDT screening providers must refer EPSDT-eligible beneficiaries to other enrolled Mississippi Medicaid licensed practitioners of the beneficiary’s choice for assessment, diagnosis and/or treatment services necessary to correct or ameliorate any physical, mental, psychosocial and/or behavioral health conditions discovered by the screenings, whether or not such services are covered under the State Plan. D. Off-site Early and Periodic Screening, Diagnosis and Treatment (EPSDT) screening providers must submit the following information to the Division of Medicaid: 1. A completed and signed secondary location form documenting the off-site provider’s ability to complete all age-appropriate components of EPSDT screenings; 2. An attestation that the EPSDT screenings will be completed by an approved EPSDT screening provider who has completed the Division of Medicaid’s EPSDT provider agreement and that all required equipment and supplies are available at the off-site location. 3. A signed agreement between the off-site location authority including, but not limited to, a school superintendent, principal, day care director, and the screening provider. 4. A list of all physical addresses of the off-site locations where the EPSDT screenings will be provided and a monthly schedule for each location designating the dates and times the EPSDT screenings will be offered. 5. Information packet materials including, but not limited to, letters, consent forms, and examples of anticipatory guidance information sheets to be provided which must be prior approved by the Division of Medicaid. 6. A copy of the provider’s Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver or CLIA number, if applicable. E. EPSDT screenings cannot begin at an off-site location until an approval has been authorized in writing by the Division of Medicaid.