Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Children ages 0-20 have access to health care services with a primary care provider (PCP). This program is called “Early and Periodic Screening, Diagnosis and Treatment” (EPSDT). This benefit covers:
- Age-based screening visits
- Services to treat physical, dental, developmental, and mental health conditions. (For OHP covered services)
- Care Coordination
- Healthcare treatment and other measures to correct or help with any defects and chronic conditions
Services are at no cost to the member. Your PCP may be a physician (MD/DO), Nurse Practitioner (NP), or Physician’s Assistant (PA). The PCP will be your main source for accessing these care visits. If you have questions about your PCP, please call Member Services.
Screening visits occur on a schedule. These visits include:
- A complete, unclothed, physical exam, including checking teeth and gums
- A health history (including both physical and mental health)
- Developmental screenings
- Screening laboratory tests (including lead toxicity testing)
- Dental Care
- Vision and hearing screenings
- Guidance and health counseling for parents and children
To access these visits, please call your PCP’s office. They will help schedule you for a visit.
Recommended vaccinations and well child visits are covered benefits. You can see the recommendations below:
- Recommendations for Preventive Pediatric Health Care by Bright Futures/American Academy of Pediatrics
Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger
Recommended Adult Immunization Schedule for ages 19 years or older
Non-Emergent Medical Transportation (NEMT) is offered to members and their families to get to these visits. Please call Bay Cities Brokerage for more information.
Referral Diagnosis and Treatment
Screenings may help a provider find a condition. You have access to get these conditions diagnosed and/or treated. You can be referred to the right provider for care.
- Explaining why a referral is needed
- Member, parent, or guardian must agree to the referral
- Help to get referred to the right provider for your needs
- Care coordination and Case management. It could be from Advanced Health or your PCP office
The following services will be provided if your screening shows you need it:
- Hearing and vision care
- Dental care
- Referrals to social services, nutrition, and education programs
Screening and treatments should be done in a timely manner, within six months of the request.
Some programs are not covered by EPSDT:
- Supplemental Nutrition Assistance Program (SNAP)
- Other social services programs
For more information, please call Member Services at 541-269-7400. We can help refer you to these programs.