epsdt part 1 - azahcccs.gov · federal statute 42 cfr 440.345 • pursuant to federal medicaid law...
TRANSCRIPT
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Back To Basics EPSDT Part 1
1/8/19
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What Does an EPSDT Visit Look Like?
Bright Futures and AHCCCS Tracking Forms
2 Reaching across Arizona to provide comprehensive quality health care for those in need
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Current EPSDT Enrollment
3 Reaching across Arizona to provide comprehensive quality health care for those in need
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Select Quality Measures
4 Reaching across Arizona to provide comprehensive quality health care for those in need
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Federal Statute 42 CFR 440.345 • Pursuant to federal Medicaid law 42 USC 1396a(a)(10), federal and
state regulations, AHCCCS policy, and contract, Title XIX Contractors must cover EPSDT services for persons under the age of 21, including screening, vision, dental, and hearing services as well as any other services listed in the Medicaid Act (regardless of whether or not in the Arizona State Plan) when “necessary to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.” EPSDT services are defined in 42 USC 1396d(r). For individuals under the age of 21, EPSDT requires that Contractors cover treatments and procedures within any of the categories of Medicaid-covered services listed in 42 USC 1396d(a) if that treatment or service is necessary to “correct or ameliorate” defects or physical and mental illnesses or conditions.
5 Reaching across Arizona to provide comprehensive quality health care for those in need
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Medicaid.gov
• https://www.medicaid.gov/medicaid/benefits/epsdt/index.html
• AHCCCS State Plan (Medicaid/CHiP) https://www.azahcccs.gov/Resources/StatePlans/
6 Reaching across Arizona to provide comprehensive quality health care for those in need
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CMSHHSgov Series (10:58)
• https://www.youtube.com/watch?v=O3cYN7z3q0M
• Modules for training staff
7 Reaching across Arizona to provide comprehensive quality health care for those in need
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Raising Healthy Arizona Kids (5:26)
• https://vimeo.com/2740145
• Parental guidance
8 Reaching across Arizona to provide comprehensive quality health care for those in need
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Bright Futures
• Periodicity Schedule: https://www.aap.org/en-us/professional-resources/practice-transformation/managing-patients/Pages/Periodicity-Schedule.aspx
• AHCCCS aligns except for 30 month EPSDT visit
• New addenda: (SDoH; ACE; PP depression)
9 Reaching across Arizona to provide comprehensive
quality health care for those in need
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AHCCCS Periodicity Schedule
10 Reaching across Arizona to provide comprehensive quality health care for those in need
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AHCCCS Periodicity Schedule
11 Reaching across Arizona to provide comprehensive quality health care for those in need
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The 6 X 15 Measure
12 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT - Newborn
13 Reaching across Arizona to provide comprehensive quality health care for those in need
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Well Child Visits – Infant (5:00)
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwia86aivKzfAhWlIjQIHdAmBp4QtwIwAHoECAkQAQ&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DyedMu9C70m4&usg=AOvVaw2527q2JmWcDaHgDG4vWH7f
• Harvard Vanguard Series
14 Reaching across Arizona to provide comprehensive
quality health care for those in need
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CDC Recommendations: Legend
15 Reaching across Arizona to provide comprehensive quality health care for those in need
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Birth to 15 months
16 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 1 Month
17 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 2 Months
18 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 4 Months
19 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 6 Months
20 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 9 Months
21 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 12 Months
22 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 12 Month (3:32)
• https://www.youtube.com/watch?v=90w3FtNQFT8
• Focus on anticipatory guidance
23 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 15 Months
24 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – Signs of Autism (6:37)
• https://www.youtube.com/watch?v=z7NeBs5wNOA
• Emphasis on early detection beginning at the 12 month EPSDT visit
25 Reaching across Arizona to provide comprehensive quality health care for those in need
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18 Months to 18 Years
26 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 18 Months
27 Reaching across Arizona to provide comprehensive quality health care for those in need
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Well Child Visit – 18 months (10:22)
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=2ahUKEwia86aivKzfAhWlIjQIHdAmBp4QtwIwAXoECAgQAQ&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DKfY635WtgJY&usg=AOvVaw0MjzJFBBnpc44fj_sG7r7q
28 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 24 Months
29 Reaching across Arizona to provide comprehensive quality health care for those in need
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30 Month EPSDT
• See Bright Futures
• NOT a separately covered AHCCCS service
30 Reaching across Arizona to provide comprehensive quality health care for those in need
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Well Child 3 Years to 6 Years Participation
31 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 3 years
32 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 4 Years
33 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 4 Years (6:21)
• https://www.youtube.com/watch?v=lbHHlbaEYMI
• Can you spot some problems?
o BP
o Visual Acuity
o Hearing
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EPSDT – 5 years
35 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 6 Years
36 Reaching across Arizona to provide comprehensive quality health care for those in need
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Well Child Visit – 7 Years (3:26)
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=2ahUKEwia86aivKzfAhWlIjQIHdAmBp4QtwIwA3oECAUQAQ&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DfDbrZlz6O7s&usg=AOvVaw29F8WMtX1RS60ryAgO5mjW
37 Reaching across Arizona to provide comprehensive
quality health care for those in need
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EPSDT – 7 to 8 Years
38 Reaching across Arizona to provide comprehensive quality health care for those in need
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EPSDT – 9 to 12 Years
39 Reaching across Arizona to provide comprehensive quality health care for those in need
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Adolescent Measure
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HHS.gov TAG Talks
• https://www.hhs.gov/ash/oah/tag/resources/multimedia/index.html
• Drug use
• Bullying
• Transition to adulthood
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EPSDT – 13 to 17 Years
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GAPS
• Guidelines for Adolescent Preventative Services
• Organize, restructure and redefine health care for children and adolescents ages 11 – 21
• Allows identification of at-risk patients and provide them with information about changing unhealthy behavior.
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GAPS Recommendations
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Example of the Tool
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Guidance
• Reassurance that information remains confidential
• Appropriate use of screening tests (i.e., sexually active adolescents)
• Use of mnemonics
• Delegate some responsibility to ancillary health care providers
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Mnemonics
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Sick Visit / EPSDT Visit
• AMPM 430 D 1 – 4
• Allowed with separate documentation
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Updating the Process
• See proposed revisions for AMPM 430
• EHR equivalents to AHCCCS paper tracking forms
• Obtaining tracking data from other sources
• Exploring interface with HIE
49 Reaching across Arizona to provide comprehensive quality health care for those in need
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Questions?
50 Reaching across Arizona to provide comprehensive quality health care for those in need
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Thank You.
51 Reaching across Arizona to provide comprehensive quality health care for those in need