How will the 2024 HHS EPSDT guidance impact state governments?

In this article, we’ll summarize the key points from the new guidance and explore how states can better serve their constituents.

EPSDT guidelines overview

On September 26, 2024, the Department of Health and Human Services (HHS) issued detailed guidance on the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements for state health officials. EPSDT, a federal law and Medicaid benefit, ensures comprehensive preventive health care for children under 21. It mandates a range of services, including well-child visits, mental health, dental, vision, and hearing services, to promote early detection and treatment of health issues and optimal health outcomes. The latest guidance from the Centers for Medicare & Medicaid Services (CMS) outlines strategies and best practices for states to enhance these services, address gaps, and improve Medicaid program oversight.

This guidance is part of HHS’s broader strategy to enhance the effectiveness of Medicaid and the Children’s Health Insurance Program (CHIP) and provide vulnerable populations with high-quality, equitable healthcare.

Takeaways for states and health officials

A thorough grasp of these guidelines enables states to address service gaps, enhance program oversight, and ensure compliance with federal mandates, ultimately fostering a healthier future for their residents.

Here is an overview of key points published in the new guidance:

Uniformity and clarity:

The need for clear, consistent and uniform guidelines has been well-documented. The goal here is to ensure that all states have a clear understanding of the EPSDT requirements and implement them uniformly. This helps to eliminate discrepancies within each state and across states, ensuring that all children receive the same level of care regardless of where they live.

Compliance and accountability:

Clear guidance helps states comply with federal requirements more easily and enhances accountability. It ensures that states fulfill their obligations under the Medicaid program and deliver necessary services to eligible children. This includes accountability in state policy decisions and effective oversight of eligibility and service authorization and delivery.

Updates and best practices:

The guidance incorporates the latest medical advancements and best practices to ensure children receive up-to-date, high-quality care that meets current standards.

Improving health outcomes:

Preventative care and early intervention are cornerstones of EPSDT. Emphasizing regular preventive care and early intervention can significantly improve health outcomes for children. Early detection and treatment of health issues can prevent more severe problems later in life and reduce the overall costs of health care.

Addressing disparities:

EPSDT is designed to improve access to healthcare addressing health disparities among children from different socioeconomic backgrounds. The guidance aims to ensure that all children, especially those from underserved or marginalized communities, have access to comprehensive health services. This helps in mitigating health disparities and promoting equity in healthcare.

With a comprehensive understanding of these key considerations, state governments will be better able to serve and support young residents and their families.

Additional considerations regarding EPSDT guidelines

States should consider additional strategies and best practices for EPSDT requirements, such as providing technical assistance, promoting awareness, expanding the workforce, and ensuring care for children with specialized needs.

Technical assistance:

CMS will provide regular webinars and additional guidance to support compliance with EPSDT requirements.

Awareness and accessibility:

States must use clear and accessible language to inform beneficiaries and assist with scheduling and transportation.

Workforce expansion:

Encouraged broadening of provider qualifications and use of telehealth to address workforce shortages.

Improved health outcomes:

Ensuring comprehensive health coverage for Medicaid-eligible children, enhancing care coordination and case management services, and promoting integrated care models leads to better health outcomes.

Compliance and best practices:

Guidance helps states align with federal requirements and adopt best practices, improving service delivery.

Systemic improvements:

Aligning state policies with EPSDT requirements promotes a holistic approach to child welfare.

Keeping these practices in mind will help state governments enhance the effectiveness of their programs, providing better health outcomes to their most vulnerable populations.

Getting started with EPSDT compliance

By understanding EPSDT guidance, state governments will be better equipped to serve children, families, and communities. The latest guidelines can help further promote early detection and treatment of health issues, improving long-term health outcomes, reducing overall healthcare costs, and engagement with hard-to-reach families.  With the right plan and resources in place, states can continue to improve the quality and accessibility of care for those who need it most.

With CAI consultancy services, states can optimize their resources to achieve the highest levels of efficiency, accuracy, and compliance, ultimately benefiting children, youth, adults, and families. Our experienced team can provide strategies and best practices for states to advance and implement these EPSDT requirements. This may include recommending policy changes, improving oversight of eligibility, enhancing the monitoring of service authorization, identifying gaps in services, and improving service delivery outcomes.

For more information or to discuss how CAI can support your state, please contact us.

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