November 20, 2014

Inspector General Says Not Enough Children Getting EPSDT Screens

On November 12, 2014  the HHS Inspector General issued a report concluding that too many children were not getting screened or were getting insufficient screenings under the Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. The report notes that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but still far below the department's 80 percent goal. See this article from the Washington Post and Kaiser Health News. The investigation was conducted to follow up on a set of recommendations on EPSDT issued by the Office of the Inspector General (OIG) in 2010.

According to the synopsis of the report, it contains no new recommendations, but reiterates the following recommendations from 2010: CMS should

  1. require States to report vision and hearing screenings,
  2. collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings,
  3. collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and
  4. identify and disseminate promising State practices for increasing children's participation in EPSDT screenings and providers' delivery of complete medical screenings.

Additional information about EPSDT may be found in EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents.  This 41-page Guidebook provides an overview of the Early and Periodic Screening, Diagnostic and Treatment services (EPSDT) and provides information on screenings, diagnostic services, the scope of treatment services, limitations on covered services, other available federal services, and access to services.