On June 20, CMS released an information bulletin to bring to the States’ attention section 12005 of the 21st Century Cures Act (the Cures Act), entitled, “Providing EPSDT Services to Children in IMDs.”  The Cures Act amends the Medicaid benefit section to require Medicaid reimbursement for Early and Periodic Screening, Diagnostic, and Treatment Services for children under age 21 who are receiving inpatient psychiatric hospital services. This shall apply to items and services furnished on or after January 1, 2019.  Essentially, states must make available any services coverable under the EPSDT benefit and under section 1905(a) of the Act that children under age 21 who are residing in an inpatient psychiatric hospital or facility are determined to need in order to correct or ameliorate health conditions, regardless of whether such services are identified in the child’s plan of care. These EPSDT services may be provided by the hospital or facility, under arrangement with a qualified non-facility provider, and/or by a qualified provider in the community not affiliated with or under arrangement with the facility.

Click here to read the information bulletin

The Academy of Pediatric Physical Therapy is pleased with CMS’ clarification of Medicaid’s responsibility to ensure coverage of medically necessary items and services for children under EPSDT.