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Keeping Kids Healthy
To Apply for benefits, click the YesNM icon on this page.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
EPSDT services ensure that children receive early detection and care, so that health problems can be diagnosed, and treatment be provided as early as possible.
Well Child Checkups
Children may go to a doctor, a nurse practitioner or a physician’s assistant for a well-child exam. Children do not need to have a specific complaint to be seen New Mexico has adopted the examination and screening guidelines recommended by the Amercian Academy of Pediatrics (APP) and Bright Futures. Detailed information regarding periodicity schedule , anticipatory guidance and screening tools can be found at: https://brightfutures.aap.org/Pages/default.aspx
Federal regulations require that providers review a child’s development at every well child visit to include the following:Medical history
- Medical history
- Measurements of height, weight and BMI
- Unclothed physical examination
- Nutrition screening
- Vision and hearing screenings
- Developmental/behavioral assessment
- Hematocrit/hemoglobin at 9 months and 13 years
- Lead screening at 12 months and 24 months
- Immunizations
- Selective screenings necessary according to risk factors
- Anticipatory Guidance
EPSDT covered Diagnostic and Treatment Services
When an examination or screening indicates the need for further evaluation, the child should be appropriately referred for diagnosis and treatment without delay. EPSDT services listed in Section 1905(a) of the Social Security Act are covered if that treatment or service is determined to be medically necessary to correct or ameliorate defects and physical and mental illnesses or conditions. This includes physical health, behavioral health, speech/language and occupational therapies; home health services, medical equipment and supplies, vision, hearing, dental, and much more. This broad coverage requirement results in a comprehensive, high-quality health benefit for children. EPSDT Benefit covers diagnostic and treatment services that ameliorate conditions.
These other benefits include but are not limited to:
- Early intervention for developmental delays
- Hospital services
- Vision and hearing services
- Dental care
- Physical, occupational, and speech therapy
- Laboratory tests, X-rays, and other imaging tests
- Pharmacy services (including some over-the-counter medicines)
- Medical supplies
- Prosthetics and orthotics
- Nutrition consultations
- Reproductive health care
- Home health and personal care services
- Case management
- Outpatient mental health testing and counseling
- Psychiatric hospital services
- Residential treatment
See also the Family Infant Toddler (FIT) Program, New Mexico Department of Health provides early intervention services to over 14,000 children age birth to three who have or who are at risk for developmental delay, and their families.
The EPSDT benefit covers a wide range of services. To access additional services for children with special needs HSD offers additional wraparound benefit programs. For more information please visit the Developmentally Disabled Waiver and Medically Fragile Waiver page.
EPSDT Electronic Visit Verification
Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider. States must require EVV use for all Medicaid-funded PCS by January 1, 2020 and HHCS by January 1, 2023.
The EVV system must be able to electronically verify, with respect to visits conducted as part of personal care services or home health care services, the following:
- the type of service performed;
- the individual receiving the service;
- the date of the service;
- the location of service delivery;
- the individual providing the service; and
- the time the service begins and ends
States are required to provide for a stakeholder process to allow input into the state’s implementation of the EVV requirement from providers of PCS and home health services, beneficiaries, family caregivers and other stakeholders.
Please contact us with any quesitons, concerns and/or comments at MADInfo.HSD@state.nm.us.
Resources
Well Child Checkups
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Immunizations
- Immunization Program – New Mexico Department of Health The goal of the program is to ensure that all New Mexicans are properly immunized against vaccine-preventable diseases.
- The Vaccines for Children (VFC) program is a federally-funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of an inability to pay.
Blood Lead Testing
The Centers for Medicare and Medicaid Services (CMS) require that all children enrolled in Medicaid have a Blood Lead Level (BLL) screening test at 12 and 24 months of age. No safe blood lead level in children has been identified and lead exposure can affect nearly any system in the body. The goal of lead screening is to identify children with elevated blood lead levels before harm occurs.
Reports
The annual EPSDT report (form CMS-416) provides basic information on participation in the Medicaid child health program. New Mexico makes annual EPSDT Participation Reports available to the public at HSD CMS 416 Report webpage.