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Well Child

Montana Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

EPSDT is the Early and Periodic Screening, Diagnosis and Treatment portion of Medicaid's comprehensive healthcare coverage for children. It is available for all children in Medicaid from birth through age 20. The EPSDT goal is to assure  individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting.

Early

Assessing and identifying health problems early

Periodic

Checking children’s health at periodic, age-appropriate intervals (well-child visits), and inter-periodic as needed (sick visits)

Screening

Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems

Diagnosis

Performing diagnostic tests to follow up when a risk is identified

Treatment

Control, correct or reduce health problems identified

Well Child Check-Ups

At the core of EPSDT is the well child visit. These regularly scheduled check-ups help your child’s primary care provider identify problems and assist with a treatment plan for your child. . By following the Bright Futures schedule of well child visits, parents can ensure their children receive the full benefit of their comprehensive health care coverage.

EPSDT well child visits include:

  • Comprehensive health & developmental history
  • Comprehensive unclothed physical examination
  • Assessment of physical, emotional & developmental health
  • Immunizations appropriate to age & health history
  • Laboratory tests (including blood lead levels)
  • Assessment of mental/behavioral health
  • Assessment of mouth, oral cavity & teeth, including referral to a dentist
  • Assessment of nutritional status
  • Assessment of vision, including referrals
  • Assessment of overall health, including referrals
  • Health education (also called anticipatory guidance)
  • Family planning services and adolescent maternity care

In addition to well child visits, EPSDT includes inter-periodic sick visits, or other visits as needed by the individual child.

Immunization Schedule  The American Academy of Pediatrics Bright Futures recommended immunization schedule for children through the age of 18.

Montana Medicaid Member Guide Learn more about Medicaid coverage through the Early and Periodic Screening, Diagnosis and Treatment Program at pages 30-31 in the handbook.

Bright Futures  A link to the American Academy of Pediatrics Bright Futures website.

Additional Services Under EPSDT

If a child (up to the age of 21), needs medically necessary services, outside the normal realm of covered services (non-covered, over the limit, does not meet criteria, etc), these can be approved on a case by case basis. EPSDT prior authorization requests must be submitted by a child’s primary care provider or medical specialist, within their scope of practice, who determines the child needs additional treatment, services, or supplies for a primary health condition.

These requests are reviewed and decision determinations completed within 2 weeks of receipt of all required documentation.

EPSDT Prior Authorization & Medical Necessity Form

For more information regarding EPSDT services contact Health Resources Division, Maternal and Child Health Nurse .

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