Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.05-007 - Child Health Services EPSDT Update #57

The Arkansas Division of IVIedical Services (DIVIS) recruits providers for medical, dental, visual, and hearing screenings and treatment services. All Child Health Services (EPSDT) providers are required to complete a provider application (DMS-652), a Medicaid contract (DMS-653) and a Request for Taxpayer Identification Number and Certification (W-9). View or print a provider application (form DMS-652), a Medicaid contract (form DMS-653) and a Request for Taxpayer Identification Number and Certification (Form W-9).

The Arkansas Medicaid Program must approve the provider application and the Medicaid contract as a condition of participation in the Medicaid Program. Persons and entities that are excluded or debarred under any state or federal law, regulation or rule are not eligible to enroll, or to remain enrolled, as Medicaid providers.

Providers must consider the screening fee designated by the Arkansas Medical Assistance Program as payment in full and are prohibited by law from requesting or receiving additional payment from the recipient or his or her responsible relatives.

Any licensed physician, family practitioner, obstetrician, pediatrician, optometrist, etc., or any outpatient hospital, community or public health clinic, supervised by a licensed physician that is enrolled in the Arkansas Medical Assistance Program and offers the screening package as outlined in the recommended screening procedures, is eligible to participate in the Child Health Services (EPSDT) Program.

In addition, providers offering screening components, including vision, hearing and dental screens, may enroll as Child Health Services (EPSDT) providers. Such providers may include optometrists, licensed audiologists and others.

In addition to signing the Medicaid application and contract, an eligible Child Health Services (EPSDT) provider must sign an agreement to participate as a Child Health Services (EPSDT) screening provider. View or print participatinq EPSDT provider aqreement. If interested, please contact the Central Child Health Services (EPSDT) Office. View or print the Central Child Health Services (EPSDT) contact information. Payment for screens performed by providers who have not signed an agreement will be denied.

When Child Health Services (EPSDT) medical screenings, medical screening components or immunizations are not performed by a physician provider, the screening provider must have a written agreement with a physician who assumes the responsibility for the provision of Child Health Services (EPSDT) screenings and immunizations and agrees:

School districts and education service cooperatives may provide all Child Health Services (CHS/EPSDT) screening services. A school district or cooperative may participate at one of two levels, as either a comprehensive screening provider who will provide all EPSDT screening components, or as a provider for vision and/or hearing screens.

Schools enrolling as comprehensive screening providers must meet the following criteria:

Schools or education service cooperatives enrolling as screeners for hearing and vision, hearing only or vision only must meet the following criteria:

The Child Health Services (CHS) Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is a federally mandated child health component of Medicaid. It is designed to bring comprehensive health care to individuals eligible for medical assistance from birth to age 21. Even if the person eligible for medical assistance is a parent, he or she is eligible for Child Health Services (EPSDT) if under age 21. Physicians and other health professionals who provide Child Health Services (EPSDT) screening may diagnose and treat health problems discovered during the EPSDT screening or may refer the child to other appropriate sources for such care.

The following is a broad definition of the components of the Child Health Services EPSDT program.

Early means as soon as possible in the child's life, or as soon as his or her family's eligibility for assistance has been established.

Periodic means at intervals established for screening by medical, dental, visual and other health care experts. The types of screening procedures performed and their frequency will depend on the child's age and health history. In Arkansas, the medical periodic screening schedule has been established following the recommendations of the American Academy of Pediatrics.

Interperiodic means providing medically necessary screenings between the recommended age ranges for medical, visual, hearing and dental screenings in order to determine the existence of suspected illnesses or conditions.

Partial means a medical screen consisting of one or more of the Child Health Services (EPSDT) medical screening components, but not all components.

Screening is the use of quick, simple procedures to sort out apparently well persons from those who may have a disease or abnormality and to identify those in need of a more definitive examination.

Diagnosis is the determination of the nature or cause of a disease or abnormality through the combined use of health history, physical, developmental and psychological examination, laboratory tests and X-rays.

Treatment means physician, hearing, visual or dental services or any other type of medical care and services recognized under state law to prevent, correct or ameliorate disease or abnormalities detected by screening or by diagnostic procedures. Treatment for conditions discovered through a screen may exceed limits of the Medicaid Program. Services not otherwise covered under the Medicaid Program will be considered for coverage if the services are prescribed by a physician as a result of an EPSDT screen. The services must be medically necessary and permitted under federal Medicaid regulations.

The child's immunization status should be assessed from the child's health record. If the child needs any immunization at the time of the screening, the immunization(s) will be administered as part of the screening process.

Immunizations for childhood diseases are exempt from primary care physician (PCP) referral requirements.

The Arkansas Medicaid program recommends that EPSDT providers follow the immunization schedule shown below as approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

The current immunization schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2004, for children through age 18 years. More information about the current immunization schedule may be found on the AAP Web site at www.aap.org/policv/0212.html. View or print the Recommended Childhood Immunization Schedule.

Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.

Note: Arkansas is not one of the selected states in which Hepatitis A immunizations are recommended. The recommendations could change, however, if there is an increase in the number of reported cases of Hepatitis A.

The Vaccines for Children (VFC) Program was established to enable free access to childhood immunizations for Medicaid-eligible children under nineteen years of age.

Arkansas Medicaid reimburses for the administrative fee for immunizations included in the Vaccines for Children (VFC) Program, which is administered by the Arkansas Department of Health (ADH). Providers may obtain the approved vaccines from the Department of Health.

To enroll in the VFC Program and obtain the vaccines, providers may contact the Arkansas Department of Health. View or print the Arkansas Department of Health contact information.

See section 212.000 for EPSDT screening terminology.

An EPSDT periodic complete medical screen includes both hearing and vision screens. Providers must not bill an EPSDT periodic or Interperiodic vision or hearing screen on the same day or within 7 days of an EPSDT complete medical screen by the same or different providers. The above billing combinations represent a duplication of services.

An EPSDT interperiodic full medical screen includes both hearing and vision screens. Providers must not bill an EPSDT periodic or Interperiodic vision screen on the same day or within 7 days of an EPSDT Interperiodic full medical screen by the same or different providers. The above billing combinations represent a duplication of services.

For routine newborn care following a vaginal delivery or C-section, procedure code 99431, 99432 or 99435 should be used one time to cover all newborn care visits by the attending physician. Payment of these codes is considered a global rate and subsequent visits may not be billed in addition to codes 99431, 99432 and 99435. These procedure codes include the physical exam of the baby and the conference(s) with newborns parent(s) and is considered to be the initial newborn care/EPSDT screen in hospital. These procedure codes should not be used for illness care (e.g. neonatal jaundice). Providers may refer to the physician manual for necessary illness codes.

All EPSDT procedure codes must be billed on the DMS-694 EPSDT claim form with the following exceptions.

Services must be filed with the appropriate national procedure codes and applicable modifiers.