WAC 182-534-0200. Enhanced payments for EPSDT well-child checkups for children in out-of-home placement

The medicaid agency covers early periodic screening, diagnosis, and treatment (EPSDT) services, as described in WAC 182-534-0100 , for children in out-of-home placement to ensure medically necessary needs are promptly addressed. (1) For the purposes of this section, out-of-home placement means temporary, 24 hour-per-day, substitute care for a child age 20 and younger: (a) Placed away from the child's parents or guardians in licensed, paid, out-of-home care; and (b) For whom the department of children, youth, and families or a tribe has placement and care authority. (2) The agency pays an enhanced fee only for well-child checkups provided to children in out-of-home placement when the placement meets the federal requirements under 42 C.F.R. Part 441, Subpart B. (3) For children in out-of-home placement, the agency exempts well-child checkups from coverage limitations, regardless of the periodicity schedule recommended by the American Academy of Pediatrics' Bright Futures guidelines or a comparable standard. The periodicity schedule is found in the agency's EPSDT well-child program billing guide. (4) The agency pays for initial health screenings for children transitioning to out-of-home placement to identify and address immediate health needs. (a) The agency pays for an initial health screening in addition to well-child checkups. (b) Children must have an initial health screen within five days of entering out-of-home placement and a required well-child checkup within 30 days of entering out-of-home placement. (c) The provider must document the initial health screening using the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Out-of-Home Placement Initial Health Screen Form (HCA 13-843). (5) The agency evaluates client files and payments made under this program. The agency may recover the enhanced payment amount when: (a) The child was not in out-of-home placement as defined in subsection (1) of this section when the EPSDT screen was provided; or (b) Documentation was not in the child's medical file.