EPSDT Data Monitoring

EPSDT Data Requirements and Opportunities

Printer-friendly Data Requirements and Opportunities (19 KB)

State Medicaid agencies are required to report annually on EPSDT services (submitted on the 416 form) The annual report provides basic information on the number of children (by age and basis of Medicaid eligibility) who receive medical or dental screens and the number referred for diagnostic or treatment services.

For the overall program, states have opportunities to:

Determine the number of screens due according to the periodicity schedule and rate of EPSDT screens
Assess the percentage of children with health problems identified through screen or diagnostic tests for whom treatment was initiated (paid for by Medicaid)
Conduct record reviews/audits.
Track pediatric providers’ billing for screens.
Monitor provider participation and utilization patterns.

In Medicaid managed care, states have opportunities to:

Require managed care organizations (MCOs) to submit encounter data for EPSDT screening.
Link databases, such as immunization registries, lead screening databases, and Head Start EPSDT data sets.
Use data to monitor performance of MCOs as part of a quality improvement/feedback loop.
Disseminate MCO performance data to serve as an incentive to report complete and accurate data.

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EPSDT Data Reporting in the Pediatric Purchasing Specifications

Printer-friendly EPSDT Data Reporting in the Pediatric Purchasing Specifications (11 KB)

GWU Medicaid Pediatric Purchasing Specifications provide illustrative language on EPSDT and serve as the "base" for GWU’s other child-related purchasing specifications. The User Guide to these specifications provides helpful information on their use.
The list below shows sample contract language regarding EPSDT data, as well as the other data topics covered.

§902. EPSDT Data

Annual Participation Report --Contractor shall collect and report, in such form and manner as Purchaser specifies, the data required to enable Purchaser to comply with the requirements of §1902(a)(43)(D) of the Social Security Act, 42 U.S.C. §1396a(a)(43)(D), as implemented by State Medicaid Manual, HCFA Pub. 45-2, Transmittal No. 86 (May, 1996) (HCFA-416 Annual Report), relating to participation by enrolled children in early and periodic screening, diagnostic, and treatment (EPSDT) services.
Compliance with EPSDT Requirements -- Contractor shall collect and report, in such form and manner as Purchaser specifies, data relating to Contractor's compliance with the requirements of §102 of Part 1[of MEDIPED] relating to the furnishing of EPSDT services to enrolled children.

§903. Public Health Data
§904. Access Data
§905. Quality Data
§906. Aggregate Utilization Data
§907. Encounter Data
§908. Complaint and Grievance Data
§909. Expenditure and Claims Data
§910. Data Relating to Practitioners
§911. Confidentiality of Data

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EPSDT Data Links to More Information

Printer-friendly Data Links to More Information (19 KB)

Federal Statistics

The Centers for Medicare and Medicaid Services (CMS) is the federal agency responsible for administering Medicaid and EPSDT.
The Maternal and Child Health Bureau (MCHB) maintains a web-based data and information site, which contains data on child health activities and outcomes in the states and territories.

Private Organizations

The Kaiser Family Foundation offers summary data on EPSDT screens.
The American Academy of Pediatrics compiles and publishes a variety of data regarding Medicaid. EPSDT, and child health. The AAP routinely produces reports on EPSDT screening rates, eligibility and enrollment, as well as payment rates.

State Examples

Ohio Medicaid Managed Care Clinic Performance Measures. Ohio Department of Job and Family Services, 2003

Other Information on EPSDT Data and Monitoring

Knowledge Path: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services. Maternal and Child Health Library, July 2003.
Child Health Toolbox: Measuring Performance in Child Health Programs. Can We Measure EPSDT? Agency for Healthcare Research and Quality, March 2002.
A presentation by Colleen Peck and others on "Measuring the Quality of Preventive Care Delivered to Young Children." This presentation from the Children's Health Measurement Initiative includes discussion of measures, tools, and quality improvement efforts.

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