CMS Issues First Major EPSDT Guidance Update in a Decade
CMS released updated guidance on the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in 2024, marking the first comprehensive policy update in approximately ten years. The guidance, issued through a state health official letter, provides states with revised operational and coverage requirements for Medicaid's mandatory pediatric benefit. This updated playbook affects how states structure EPSDT services, including screening schedules, diagnostic services, and treatment coverage for Medicaid-enrolled children. The guidance clarifies federal expectations for state compliance and likely impacts how managed care organizations implement and document EPSDT services in their contracts.
Managed care organizations must review their EPSDT policies, provider contracts, and utilization management processes to ensure compliance with the updated federal standards, as state contracts will likely incorporate these revised requirements.
Managed Care · CHIP
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