Tennessee Caring for Kids is TennCare 's program for assuring early medical screenings for children, in accordance with the federal Early Periodic Screening, Diagnostic, and Treatment (EPSDT) Services. The purpose of the Caring for Kids (EPSDT) program is to assure that TennCare eligible children under the age of 21 receive regular screenings to identify potential health, developmental, and behavioral problems so that these problems can be treated before they become worse.

Every child (under 21 years) who is eligible for TennCare is eligible for EPSDT services. A child can be eligible for TennCare through Medicaid or through the Uninsured or Uninsurable guidelines. EPSDT screenings are well-child checkups for children and adolescents. These screening are the initial step in identifying children with needs requiring more in-depth testing and diagnostic procedures.

EPSDT screenings should be performed according to the standards of the American Academy of Pediatrics and include the following components:

• Comprehensive health and developmental history - Includes an assessment of both physical and mental health development;
• Comprehensive UNCLOTHED physical exam;
• Appropriate immunizations - According to age and health history and the schedule established by the Advisory Committee on Immunization Practices (APIC) for pediatric vaccines; Recommended Immunization Schedule
• Laboratory test - Includes blood lead level assessment appropriate for age and risk factors;
• Health Education - Health education is a required component of screening services and includes anticipatory guidance. Health education should assist the parent and/or guardian in understanding what to expect in terms of the child's development and to provider information about the benefits of health lifestyles and practices as well as accident and disease prevention;
• Vision Screens - Includes an age-appropriate vision assessment. Tools used for screening shall be consistent with recommendations from the Early Care (EPSDT) Screening Guidelines Committee. Vision services at a minimum include diagnosis and treatment for defects in vision, including eyeglasses;
• Hearing Screens - Includes an age-appropriate hearing assessment. Tools used for hearing screenings shall be consistent with EPSDT Screening Guidelines. Hearing services at a minimum include diagnosis and treatment for defects in hearing, including hearing aids;
• Dental Services - At a minimum, to include relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services. Although an oral screening may be part of the physical examination, it does not substitute for examination through direct referral to a dentist. A direct dental referral is required for every child beginning at the age 3, or earlier if determined to be medically necessary; and,
• Other Necessary Health Care Services - Includes other necessary health care, diagnostic services, treatment, and other measures described in the Social Security Act to correct, or ameliorate defects, and physical and mental illness and conditions discovered by the screening services.

When a screening examination indicates the need for further evaluation of an individual's health, diagnostic services should be provided. The referral should be made without delay and followed-up to confirm that the enrollee receives a complete diagnostic evaluation.

Providers who perform EPSDT screens may identify potential health, behavioral, or developmental problems. They are responsible for making referrals to other VHP providers for further testing or treatment. While there is no requirement that periodic or interperiodic screenings meet the definition of "medically necessary," additional testing and treatment services must be medically necessary. Screening follow-ups are just as important as the initial screenings.

In addition to covering scheduled periodic check-ups, EPSDT covers visits to a health care provider when needed outside of the periodicity schedule to determine whether a child has a condition that needs further care. These types of screens are called "interperiodic screens." Persons outside the health care system such as a teacher or parent can determine the need for an interperiodic screen. Screenings shall be performed at distinct intervals and in accordance with the American Academy of Pediatrics Recommendations for Pediatric Health Care.

Non-emergent transportation services to members who require such a service will be provided. Services will not be restricted due to age or lack of parental accompaniment. Transportation assistance includes "related travel expenses" such as the cost of meals and lodging en route to and from care and the cost of an attendant to accompany a child if necessary.

Screening services must be provided in accordance with "reasonable standards of medical and dental practice" as determined by the State. The State has determined that "reasonable standards of medical and dental practice" are those standards set forth in the American Academy of Pediatrics Recommendation For Preventive Pediatric Health Care. Pursuant to the TennCare / MCO Contractor Risk Agreement Section 2-3.a.1, "screens shall be in accordance with the periodicity schedule set forth in the latest 'American Academy of Pediatrics Recommendations For Preventive Pediatric Health Care' and all components of the screens must be consistent with the latest 'American Academy of Pediatrics Recommendations For Preventive Pediatric Health Care.'"

An important source of information for determining what EPSDT services were delivered is coding of the encounter. Encounter codes are used to direct auditors in determining what visits are to be considered as being EPSDT. The following is a list of EPSDT procedure and diagnosis codes issued by TennCare and should be implemented.

PLEASE BE SURE TO USE THE APPROPRIATE CODE FOR ANY EPSDT SERVICES PROVIDED DURING PERIODIOTIC OR INTERPERIODIC VISITS.