Effective Date: Immediately

Health Plans Affected: Priority Partners

Type of Change: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Measures

Explanation of Change:

EPSDT is a Medicaid benefit that continues until age 21, regardless of whether the patient sees a pediatrician or adult medicine provider. When an Internal Medicine or Family Medicine provider accepts a Medicaid patient under 21 who has transitioned from pediatric care, they generally are expected to:

1. Continue periodic screenings according to Maryland's periodicity schedule (aligned with AAP/Bright Futures guidelines)
   
2. Provide or refer for required components:
   • Comprehensive health and developmental history
     
   • Physical examination
     
   • Immunizations (per ACIP schedule)
     
   • Laboratory tests (including lead screening if applicable)
     
   • Vision screening
     
   • Dental referral
     
   • Hearing screening
     
   • Health education
3. Ensure access to medically necessary treatment identified through screenings
   

Practical Considerations

• Many internal medicine providers may be unfamiliar with EPSDT requirements since they typically see adult populations.
  
• Documentation of screenings is essential for compliance.
  
• Priority Partners tracks EPSDT compliance and may reach out regarding gaps in care.
  
• Please contact Priority Partners or Maryland Medicaid for current guidance on periodicity schedules and billing codes for patients ages 18-21.