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CHDP DIRECTOR/DEPUTY DIRECTOR TRAINING SECTION III
EPSDT: A Comprehensive Child Health Program
1
7/1/2010
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EPSDT
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E EarlyP PeriodicS ScreeningD DiagnosisT Treatment
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EPSDT3
EPSDT is a Federal requirement outlined in the State Medicaid Manual published by the Centers for Medicare and Medicaid Services.
EPSDT Regulations provide the framework for the CHDP Program.
Deputy Directors should be familiar with EPSDT Regulations.
Access CMS Publication #45 State Medicaid Manual http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?itemID=CMS021927 for the complete text.
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California’s Implementation of EPSDT
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California Implementing EPSDT
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States have flexibility on how they implement the Federal EPSDT Program.
CHDP is how California meets the EPS portion of the EPSDT requirements.
The guiding document for CHDP is part of California Code of Regulations Title 17.
Access Title 17 from the CHDP Home page under Program Overview.
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Informing6
The responsibilities for “Informing Families” are set in written format and agreed upon by CHDP, Department of Social Services and Probation in the CHDP Interagency Agreement (IAA).
“Informing Families” is comprised of both basic informing and intensive informing activities. Basic informing is carried out by Social Services and Probation staff. Intensive informing is conducted by CHDP staff.
An IAA model format is available in the Plan and Fiscal Guidelines (PFG).
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Basic Informing7
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Basic Informing8
To Whom?
All CalWorks & Medi-Cal eligible families with children under 21 years Newly eligible Upon renewal (annual) Those who have not used EPSDT services for
at least one year Children in foster care with federally
funded benefits Medi-Cal eligible pregnant women
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Basic Informing9
How? Face-to-face, oral and written methods
CHDP Information Brochure* Clear, non-technical, understandable
information Must include means to communicate with
those who are deaf, blind, illiterate or not able to read or understand the English language
* Any revision to the content of the CHDP Information Brochure must be approved by the State.
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Basic Informing10
About What?
Benefits of preventive health and dental care
What health and dental services are offered Periodicity schedule summary Ability to receive initial and periodic health
and dental exams per the periodicity schedule
Treatment is provided for problems detected during screening 7/1/2010
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Basic Informing11
How to obtain medical and dental services How to get contact information for CHDP
providers Declined services at time of informing can
be requested at later time as long as Medi-Cal eligible
Able to go to CHDP provider of choice; if full range of CHDP services not offered by provider, can receive balance of services, along with scheduling and transportation assistance upon request to CHDP program or welfare department
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Basic Informing12
Assistance in referral shall be provided
Transportation assistance provided if requested
Scheduling assistance provided if requested
CHDP services from approved providers are at no cost
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The CHDP Referral (PM 357)
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The CHDP Referral (PM 357)14
The Eligibility Worker, Probation Officer, or Social Worker is required to ask whether the client: Wants more information about CHDP Wants CHDP medical or dental services Needs scheduling or transportation assistance
to obtain CHDP medical and/or dental services Any with “Yes” responses must be sent to
the CHDP Program on a CHDP Referral (PM 357) for intensive informing
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Intensive Informing15
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Intensive Informing16
About What?
The value of preventive health services The availability of CHDP health
assessments The need for prompt diagnosis and
treatment of suspected disabilities The nature, scope, and benefits of CHDP Assistance with scheduling and
transportation if requested
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Intensive Informing
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How? CHDP or HCPCFC staff use a combination of
methods: telephone, home visit, face-to-face, office visit, or
letter.
A good faith effort will be made to locate all persons lost to contact and includes query of the local welfare department for current address, telephone number, and Medi-Cal status. (Reference: Joint Social Services/CHDP Responsibilities section of the CHDP IAA model format in PFG)
Document the contact efforts! 7/1/2010
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Intensive Informing18
To Whom?
Those requesting more information Those requesting assistance with
scheduling and transportation to medical and/or dental appointments
CHDP follow-up of referrals must be documented.
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Sample PM 357 #1
Below is an example of the portion of a PM 357 of a client requesting additional information.
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Sample PM 357 #2
Below is an example of the portion of a PM 357 of a client requesting assistance with scheduling of a medical appointment.
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Required Documentation 21
Contact efforts: method, date, name of person contacted
Type of assistance given Date(s) of appointments and name of
provider(s) Confirmation of CHDP medical and/or
dental services may be obtained from family, provider, or PM 160
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Goal of Informing Activities22
Outreach and Health Education services shall bedesigned to ensure that the only reason eligible persons do not participate in the health assessment and referral for diagnosis and treatment portions of the program is because:
They intelligently and knowingly decline such participation for reasons unrelated to availability and accessibility of the health assessment, diagnosis and treatment services.
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Deputy Director’s Responsibilities
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Deputy Director’s Responsibilities
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Assure that timely basic informing training occurs Eligibility Workers, Child Welfare Social Workers
& Probation Officers must receive basic informing orientation within 90 days of employment and annually
Orientation includes: Description of CHDP Available services Legal mandate to provide basic informing How to provide basic informing How to fill out the PM357 and where to send it
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Deputy Director’s Responsibilities
25
Assure any diagnostic and treatment services are initiated within 120 days of eligibility determination.
Assure documentation of Intensive Informing efforts is complete.
Maintain data required for annual reporting (CHDP Program Referral Data Form in current PFG).
Retain records for three years in addition to current year.
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Resources26
CMS Publication #45 State Medicaid Manual http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?itemID=CMS021927
California Code of Regulations Title 17 (link available from CHDP Home page, Program Overview)
CHDP Information Brochure (online at CHDP Homepage)
CHDP Program Letter 81-5 County CHDP Interagency Agreement CMS Plan & Fiscal Guidelines Section 4
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