Medicaid Periodicity Schedule
To ensure the highest quality care to children enrolled in the South Carolina Medicaid program, the South Carolina Department of Health and Human Services (SCDHHS) adopts the following updates and reminders regarding Early and Periodic Screening, Diagnostic, & Treatment (EPSDT) coverage policy. The EPSDT benefit is available to Medicaid beneficiaries under the age of 21.
Medical Periodicity Schedule
Effective May 1, 2018, SCDHHS is adopting the current edition of the Bright Futures Recommendations for Preventive Pediatric Health Care as the medical periodicity schedule. This schedule, published by the American Academy of Pediatrics (AAP), is available at www.aap.org.
Requirements for oral health preventative care are included on a separate Oral Health Periodicity Schedule, available at https://www.scdhhs.gov/resources/programs-and-initiatives/epsdt/providers/periodicity-schedule.
Children should be referred to a dentist for routine care, preventive services and examination at the eruption of first tooth, but no later than 12 months of age, to ensure establishment of a dental home.
Developmental and Behavioral Health Screenings and Assessments
The EPSDT benefit includes follow-up developmental and behavioral health screenings and assessments that are indicated by the findings of the general screening during a periodic or interperiodic visit.
The EPSDT benefit covers age-appropriate immunizations, in accordance with the schedule for pediatric vaccines established by the Advisory Committee on Immunization Practices. Generally, SCDHHS provides for pediatric immunization coverage through the Vaccines for Children (VFC) program. For more information on billing pediatric immunizations and VFC, please refer to the Physicians, Laboratories and Other Medical Professionals Provider Manual at https://www.scdhhs.gov/provider-manual-list.
Children enrolled in Medicaid must receive blood lead screening at ages 12 months and 24 months. Additionally, any child between ages 24 and 72 months with no record of a previous blood lead screening test must receive one. The completion of a risk assessment does not meet SCDHHS requirements.
In collecting blood samples for lead testing, providers are required to follow the specimen and collection guidelines developed by the SC Department of Health and Environmental Control (SCDHEC). These guidelines are available on the SCDHEC Bureau of Laboratories webpage at http://www.scdhec.gov/health/lab.
The South Carolina Code of Laws, Section 44-53-1380, requires that any physician, hospital, public health nurse or other diagnosing person or agency report known or suspected cases of lead poisoning to the SCDHEC within seven days. If you would like more information about the South Carolina Childhood Lead Poisoning Prevention Program, please call (866) 466-5323.
For questions regarding this bulletin, please contact the SCDHHS Provider Service Center at (888) 289-0709.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.