EPSDT

AmeriHealth Mercy covers Pediatric Preventive Care to members younger than 21 years of age through a special health care program called EPSDT.  This stands for Early and Periodic Screening, Diagnosis and Treatment. The program is designed to make sure that children get the medical screening and testing they need to help prevent and/or find out about childhood diseases and illnesses early.

To keep your children healthy, regular EPSDT screens should be scheduled with your child’s PCP. Your child’s PCP can provide the following EPSDT services:

• Well child visits with a complete physical exam
• Immunizations (shots)
• Laboratory tests, including blood and urine
• Vision and hearing screens
• Dental screen
• TB testing
• Health education
• Comprehensive health and developmental history
• Blood lead level tests
• Developmental and nutritional checks
• Referral to a specialist, when medically necessary

Additionally, for members under two years of age, the Pediatric Preventive Care program provides the following outreach services:

• Telephone calls to parents/guardians to remind them that EPSDT services are due.
• Telephone calls by Case Managers to parents/guardians of children under age one who have no history of immunizations or who have not completed their immunization schedule .
• Access to information on growth and development, lead poisoning and safety, via an audio library.

All children from age two up to 21 are eligible for the following services:

• Annual birthday reminder card identifying EPSDT services necessary to monitor and ensure age appropriate growth and development.
• Targeted case management for children identified with “high” lead levels.
• Informational materials, via mail, to parents/guardians of children with “above normal” lead levels.
• Follow-up for members referred to expanded services by their PCP or specialist.
• Care coordination for specialized services, including access to community resources and programs.

If you have questions or want to find out more about this program, you can call Member Services and ask for an EPSDT Case Manager.

An EPSDT Case Manager can:

• Help you understand the EPSDT Program
• Answer your questions
• Remind you to schedule EPSDT Screens
• Help you make an appointment
• Work with your child’s PCP
• Assist you in arranging transportation

EPSDT Expanded Services
EPSDT has other services for children with special health care needs. These services are called “expanded services” and may not normally be covered by the Pennsylvania Medical Assistance Program. If your child has a special health care need, he or she may be eligible for these services. Talk to your child’s PCP and the PCP can talk to a Case Manager about getting approval for these expanded services.