EPSDT/HealthCheck guidelines

What is EPSDT/HealthCheck?

AmeriHealth Caritas DC PCPs are responsible for providing Early Periodic Screening, Diagnosis and Treatment (EPSDT) or “HealthCheck” services to enrollees from birth to age 21, according to the D.C. Medicaid HealthCheck periodicity schedule (PDF), or upon request at other times in order to determine the existence of a physical or mental condition..

What is required of providers?

Required screenings
For the initial examination and assessment of a child, PCPs are required to perform:

• All relevant HealthCheck screenings and services, according to the periodicity schedule (including autism screenings for children ages 18 months and 24 months); and
• Any additional assessments, using the appropriate tools, to determine whether or not a child has special health care needs. Report determinations to the Rapid Response team at 1-877-759-6224.

Screening timeframes
HealthCheck providers are contractually obligated to provide HealthCheck screenings within 30 days of the scheduled due date for children under the age of two years and within 60 days of the scheduled due date for children age two and older. For all other pediatric enrollees, initial HealthCheck screenings must be offered within 60 days of becoming a plan enrollee.

Required trainings
HealthCheck providers are required to complete the District’s HealthCheck Provider Training Module within 30 days of joining the Plan network and every two years after the initial training. This program is accessible online at www.dchealthcheck.net and requires a provider’s NPI to log in. The training program is free for participating plan providers who are due to receive the training.

Enrollee education on EPSDT
HealthCheck providers are expected to provide written and verbal explanation of EPSDT services to plan enrollees including pregnant women, parent(s) and/or guardian(s), child custodians and sui juris teenagers. This explanation of EPSDT services should occur on the enrollee's first visit, and quarterly thereafter, and must include distribution of appropriate EPSDT educational tools and materials.

Resources

• Well-Child Guide (PDF)
• CARE Card
• Well-Child Visit Billing Reference Guide (PDF)

For more information regarding EPSDT/HealthCheck, refer to your provider manual, or call Provider Services at 1-202-408-2237 or 1-888-656-2383.