The medicaid agency pays providers an enhanced fee for Early
and Periodic Screening, Diagnostic, and Treatment (EPSDT) screens provided to
children in out-of-home placement. See the agency's EPSDT provider guide for
specific billing code requirements, and see the agency's fee schedule for the
fee.
(1) For the purposes of this
section, out-of-home placement means temporary, 24 hour per day, substitute
care for a child:
(a) Placed away from the
child's parents or guardians in licensed, paid, out-of-home care; and
(b) For whom the department of social and
health services or a licensed or certified child placing agency has placement
and care responsibility.
(2) The agency pays an enhanced fee to the
providers listed in subsection (3) of this section for EPSDT screens provided
to only those children in out-of-home placement.
(3) The following providers are eligible to
perform EPSDT screens and bill the enhanced rate for children in out-of-home
placement:
(a) EPSDT clinics;
(b) Physicians;
(c) Advanced registered nurse practitioners
(ARNPs); and
(d) Physician
assistants (PAs).
(4) To
be paid an enhanced fee, services furnished by the providers listed in
subsection (3) of this section must meet the federal requirements for EPSDT
screens at 42 C.F.R. Part
441 Subpart B.
(5) The provider must retain documentation of
the EPSDT screens in the client's medical file. The provider must use the
agency's Well Child Exam forms or provide equivalent information. The Well
Child Exam forms include the required elements for an EPSDT screen. The Well
Child Exam forms are available for downloading at no charge at
http://www.hca.wa.gov/medicaid/forms/Pages/index.aspx.
(6) The agency evaluates client files and
payments made under this program. The agency may recover the enhanced payment
amount when:
(a) The client was not in
out-of-home placement as defined in subsection (1) of this section when the
EPSDT screen was provided; or
(b)
Documentation was not in the client's medical file (see subsection (5) of this
section).
Notes
Wash. Admin.
Code §
182-534-0200
Amended by
WSR
15-12-074, Filed 5/29/2015, effective
7/1/2015
Amended by
WSR
24-21-163, Filed 10/23/2024, effective
11/23/2024
11-14-075, recodified as §182-534-0200, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090. 10-19-057, § 388-534-0200, filed
9/14/10, effective 10/15/10. Statutory Authority:
RCW
74.04.050,
74.04.055,
74.04.057,
74.08.090, 42 C.F.R., Part 441,
Subpart B. 02-07-016, § 388-534-0200, filed 3/8/02, effective
4/8/02.
