PDFWAC 182-534-0200
Enhanced payments for EPSDT well-child checkups for children in out-of-home placement.
The medicaid agency covers early periodic screening, diagnosis, and treatment (EPSDT) services, as described in WAC 182-534-0100, for children in out-of-home placement to ensure medically necessary needs are promptly addressed.
(1) For the purposes of this section, out-of-home placement means temporary, 24 hour-per-day, substitute care for a child age 20 and younger:
(a) Placed away from the child's parents or guardians in licensed, paid, out-of-home care; and
(b) For whom the department of children, youth, and families or a tribe has placement and care authority.
(2) The agency pays an enhanced fee only for well-child checkups provided to children in out-of-home placement when the placement meets the federal requirements under 42 C.F.R. Part 441, Subpart B.
(3) For children in out-of-home placement, the agency exempts well-child checkups from coverage limitations, regardless of the periodicity schedule recommended by the American Academy of Pediatrics' Bright Futures guidelines or a comparable standard. The periodicity schedule is found in the agency's EPSDT well-child program billing guide.
(4) The agency pays for initial health screenings for children transitioning to out-of-home placement to identify and address immediate health needs.
(a) The agency pays for an initial health screening in addition to well-child checkups.
(b) Children must have an initial health screen within five days of entering out-of-home placement and a required well-child checkup within 30 days of entering out-of-home placement.
(c) The provider must document the initial health screening using the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Out-of-Home Placement Initial Health Screen Form (HCA 13-843).
(5) The agency evaluates client files and payments made under this program. The agency may recover the enhanced payment amount when:
(a) The child was not in out-of-home placement as defined in subsection (1) of this section when the EPSDT screen was provided; or
(b) Documentation was not in the child's medical file.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-13-048, s 182-534-0200, filed 6/11/25, effective 7/12/25; WSR 24-21-163, s 182-534-0200, filed 10/23/24, effective 11/23/24; WSR 15-12-074, § 182-534-0200, filed 5/29/15, effective 7/1/15. WSR 11-14-075, recodified as § 182-534-0200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-534-0200, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, 42 C.F.R., Part 441, Subpart B. WSR 02-07-016, § 388-534-0200, filed 3/8/02, effective 4/8/02.]