Current through Register Vol. 56, No. 18, September 16, 2024
(a) The early
and periodic screening, diagnostic and treatment (EPSDT) services program is a
Federally mandated comprehensive child health program for Medicaid and NJ
FamilyCare fee-for-service beneficiaries from birth through 20 years of age.
(See 42 CFR 441 Subpart B.)
(b)
EPSDT includes screening services; vision services; dental services; hearing
services; and other necessary health care, diagnostic services, treatment and
other measures to correct or ameliorate defects and physical and mental
illnesses and conditions discovered by the screening services.
1. An expanded program for Medicaid and NJ
FamilyCare fee-for-service beneficiaries up to the age of two is known as
HealthStart. For additional information, including provider enrollment
requirements, see N.J.A.C. 10:66-3.
(c) Components of an EPSDT screening are as
follows:
1. A comprehensive health and
developmental history including assessment of both physical and mental health
development;
2. A comprehensive
unclothed physical exam including vision and hearing screening, dental
inspection, and nutritional assessment;
3. Appropriate immunizations according to age
and health history;
4. Appropriate
tests, including:
i.
Hemoglobin/hematocrit;
ii.
Urinalysis;
iii. Tuberculin
test;
iv. Blood lead level
assessment shall be performed for all children between nine through 18 months
of age (preferably at 12 months) and again at two years of age. In addition,
between the ages of two and six years, a child shall be screened if there is no
evidence of prior screening;
v.
Other medically-necessary procedures;
5. Health education, including anticipatory
guidance; and
6. Referral for
further diagnosis and treatment or follow up to correct or ameliorate
abnormalities, uncovered or suspected. Referral may be to the provider
conducting the screening examination, or to another provider, as
appropriate.
(d) EPSDT
screening services (unless modified as follows in (e), (f) and (g) below) shall
be provided periodically according to the following schedule which reflects the
age of the child:
1. Under six
weeks;
2. Two months;
3. Four months;
4. Six months;
5. Nine months;
6. 12 months;
7. 15 months;
8. 18 months;
9. 24 months; and
10. Annually through age 20.
(e) Vision screening shall include
the following:
1. A newborn examination
including general inspection of the eyes, visualization of the red reflex, and
evaluation of ocular motility;
2.
An appropriate medical and family history;
3. An evaluation, by age six months, of eye
fixation preference, muscle imbalance, and pupillary light reflex;
4. A repeated examination with visual acuity
testing by age three or four years;
5. Periodicity testing for school-aged
children as follows:
i. Kindergarten or first
grade (five or six years);
ii.
Second grade (seven years);
iii.
Fifth grade (10-11 years);
iv.
Eighth grade (13-14 years); and
v.
Tenth or eleventh grades (15-17 years).
6. Children should be referred for further
evaluation if they:
i. Cannot read the
majority of the 20/40 line before their fifth birthday;
ii. Have a two-line difference of visual
acuity between the eyes;
iii. Have
suspected strabismus; or
iv. Have
an abnormal light or red reflex.
(f) The following apply to dental screening:
1. Intraoral examination is an integral part
of a general physical examination.
2. A formal referral to a dentist is
recommended at one year of age. It is mandatory for children three years of age
and older.
3. Dental inspection and
prophylaxis should be carried out every six months until 17 years of age, then
annually.
(g) The
following apply to hearing screening:
1.
Hearing screening shall be included in all preventive periodic
examinations.
2. Audiometric
testing shall be administered annually to all children between three and eight
years of age. After age eight, children shall be tested every other
year.
