OAR 410-130-0245
Early and Periodic Screening, Diagnostic and Treatment Program
(1)
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, formerly called Medicheck, offers “well-child” medical exams with referral for medically appropriate comprehensive diagnosis and treatment for all children (birth through age 20) covered by the Oregon Health Plan (OHP) Plus benefit package.(2)
Screening Exams:(a)
Physicians (MD or DO), nurse practitioners, licensed physician assistants and other licensed health professionals may provide EPSDT services. Screening services are based on the definition of “Preventive Services” in Oregon Health Plan OAR 410-141-0000, Definitions;(b)
Periodic EPSDT screening exams must include:(A)
A comprehensive health and developmental history including assessment of both physical and mental health development;(B)
Assessment of nutritional status;(C)
Comprehensive unclothed physical exam including inspection of teeth and gums;(D)
Appropriate immunizations;(E)
Lead testing as required by OAR 410-130-0246 (Lead Screening);(F)
Other appropriate laboratory tests (such as anemia test, sickle cell test, and others) based on age and client risk;(G)
Health education including anticipatory guidance;(H)
Appropriate hearing and vision screening.(c)
The provider may bill for both lab and non-lab services using the appropriate Current Procedural Terminology (CPT) and Health care Common Procedure Coding System (HCPCS) codes. Immunizations must be billed according to the guidelines listed in OAR 410-130-0255 (Immunizations, Vaccines for Children, and Immune Globulins);(d)
Inter-periodic EPSDT screening exams are any medically appropriate encounters with a physician (MD or DO), nurse practitioner, licensed physician assistant, or other licensed health professional within their scope of practice.(3)
Referrals:(a)
If, during the screening process (periodic or inter-periodic), a medical, mental health, substance abuse, or dental condition is discovered, the client may be referred to an appropriate provider for further diagnosis and/or treatment;(b)
The screening provider shall explain the need for the referral to the client, client’s parent, or guardian;(c)
If the client, client’s parent, or guardian agrees to the referral, assistance in finding an appropriate referral provider and making an appointment should be offered;
Source:
Rule 410-130-0245 — Early and Periodic Screening, Diagnostic and Treatment Program, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-130-0245.