37.86.2201    EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , PURPOSE, ELIGIBILITY, AND SCOPE

(1) The early and periodic screening, diagnostic and treatment services (EPSDT) are preventive health screenings, diagnostic services, and medically necessary treatment services as specified in these rules.

(2) Services provided for EPSDT purposes are only available to Medicaid eligible persons up to and including 20 years of age.

(3) Limitations on the amount, scope or duration for particular services, funded with Medicaid monies, do not apply to such services when provided to EPSDT recipients unless otherwise provided in these rules.

(4) Criteria, requirements, and limitations applicable to eligibility for and the receipt of home and community services provided under a Medicaid waiver, govern the provision of waiver and EPSDT services to persons who are eligible for both EPSDT and waiver services.

(5) Criteria, requirements and limitations generally applicable to Medicaid services, recipients, or providers, including but not limited to medical necessity requirements, experimental or cosmetic service exclusions, prior authorization, prescreening, certification or utilization review requirements, provider participation, billing or reimbursement requirements, recipient eligibility or copayment requirements, or other similar requirements or restrictions apply to EPSDT recipients, EPSDT services, and providers of services to EPSDT recipients.

(6) An EPSDT service may only be provided by a provider that is appropriate and qualified to deliver the service in accordance with the relevant and applicable educational, professional and licensing standards and requirements.

(7) An EPSDT service must be delivered in accordance with those standards and requirements applicable to the provision of the service.

(8) School based health related services may only be provided in public school districts, full-service education cooperatives and joint boards described in ARM 37.86.2231.

(9) A service, item or provider category is not available as an EPSDT service unless made available in accordance with these rules.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1980 MAR p. 1790, Eff. 6/27/80; AMD, 1987 MAR p. 205, Eff. 2/27/87; AMD, 1990 MAR p. 2299, Eff. 12/28/90; AMD, 1992 MAR p. 2788, Eff. 1/1/93; AMD, 1995 MAR p. 2501, Eff. 11/23/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1998 MAR p. 3219, Eff. 12/4/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2003 MAR p. 1316, Eff. 6/27/03.