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Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) 

Early and Periodic Screening, Diagnosis, & Treatment (EPSDT) is a Medi-Cal benefit for individuals under the age of 21 who have full-scope Medi-Cal eligibility.  This benefit allows for periodic screenings to determine health care needs.  Based upon the identified health   care need and diagnosis; treatment services are provided.  EPSDT services include all services covered by Medi-Cal.  In addition to the regular Medi-Cal benefits, a beneficiary under the age of 21 may receive additionally medically necessary services.

How Does One Request EPSDT Skilled Nursing Services?

For full scope Medi-Cal beneficiaries, the provider must submit a Treatment Authorization Request (TAR) for Pediatric Day Health Care (PDHC) and Private Duty Nursing (PDN) services. For TAR information, refer to the TAR Overview section of the Medi-Cal Provider Manual.   In addition to the TAR, the provider must also submit the following medical documentation:

  • Plan of Treatment (POT) signed by a physician (within 30 days);
  • Nursing Assessment (within 30 days);
  • Medical information supporting the nursing services requested, i.e. medication record, discharge summary notes, and treatment notes.

 

What if a CCS-Eligible Child is Enrolled in a Medi-Cal Managed Care Plan?

For beneficiaries enrolled in a Medi-Cal Managed Care Plan with carved out California Children’s Services (CCS),

  • who have a CCS-eligible medical condition, and
  • who have been referred to the CCS program for case management and authorization of services, requests for authorization of Private Duty Nursing (PDN) services that are related to a child’s CCS-eligible medical condition will be referred to the CCS program for review and authorization of a Service Authorization Request (SAR). 

 

Providers in Alpine, Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Inyo, Lake, Lassen, Mariposa, Modoc, Mono, Nevada, Plumas, San Benito, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne and Yuba counties must fax a SAR for Private Duty Nursing (PDN) to the Los Angeles Office – EPSDT Unit at (916) 440-5758. 

For general SAR information, refer to the California Children’s Services (CCS) Program-Service Authorization Request (SAR) section of the Medi-Cal Provider Manual. In addition to the SAR, the provider must also submit the following medical documentation:

  • Plan of Treatment (POT) signed by a physician (within 30 days);
  • Nursing Assessment (within 30 days)
  • Medical information supporting the nursing services requested, i.e. medication record, discharge summary notes, and treatment notes.

 

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