The mission of the Maryland Health Kids/EPSDT Program is to ensure access and availability of quality health care for Medical Assistance children, teens, and young adults less than 21 years of age. The goal of the program is to provide appropriate practice-based performance improvement assessments and targeted interventions to enhance the quality of health services delivered by Medicaid providers to eligible recipients less than 21 years of age.
Each year, the Maryland Department of Health (MDH) evaluates the quality of care (QOC) provided to Maryland medical assistance recipients enrolled in a HealthChoice Managed Care Organization (MCO). The MDH contracts with Qlarant to serve as the External Quality Review Organization (EQRO). Beginning with calendar year 2007 services, Qlarant began performing an annual medical record review of preventive services performed, according to Maryland’s Schedule of Preventive Health Care for HealthChoice children up to the age of 20.
Each MCO is assessed using five components. The components reviewed are: Health and Developmental History; Comprehensive Physical Examination; Laboratory Tests/At-Risk Screenings; Immunizations; and Health Education/Anticipatory Guidance.
A minimum performance score of 80% is required for each component. For 2019 (based on review of calendar year 2018 medical records), the composite score for MedStar Family Choice was 94 % (an increase by 2%), which equaled the statewide overall HealthChoice Composite score of 94%. MedStar Family Choice scored above 80% in all five components. MedStar Family Choice scored above, equaled or met the HealthChoice Aggregate score in all five components.
It is important to note that MedStar Family Choice EPSDT certified providers are required to follow the MDH Immunization Schedule; the schedule for performing the required screening and laboratory tests as identified in the Maryland HealthChoice Well Child Care Schedule, as well as the age specific EPSDT developmental forms and Preventive Screen Questionnaires. MedStar Family Choice EPSDT certified providers are strongly encouraged to use the Maryland IMMUNET site online for tracking and updating immunizations and to follow up with lab results and referrals.
MedStar Family Choice EPSDT certified providers should pay particular attention to the screenings: Developmental, Autism, Cholesterol Risk, Substance Abuse, and Depression Screenings. MedStar Family Choice improved on Comprehensive Physical Exam and Immunizations. MFC falls short on required documentation of a family history, perinatal history, maternal depression, documentation of a return visit for the child, dental assessments and referral, documentation of a blood pressure and the required risk assessments for STI/STD, cholesterol, TB, lead, anemia and the actual blood tests for cholesterol, TB, lead, HIV and anemia.
We recommend and encourage our providers to include documentation in the medical record of: The initial family history, updates to family history, well child encounter form, risk assessment/screen questionnaires for autism, depression, cholesterol, TB, substance abuse, lead & anemia, copy of lab(s) referrals, perinatal history, newborn screening results, substance abuse assessment, dental assessment and referals and immunization record in order to support the EPSDT services that were rendered.
MDH makes helpful forms available for use by providers on their website at https://mmcp.health.maryland.gov/epsdt/healthykids/Pages/Encounter-Forms.aspx. If you are unable to print a copy of any of the EPSDT forms, you can contact MFC Provider Relations Department at 800-905-1722, option 5, and a sample will be provided.
MedStar Family Choice would like to thank all of our providers for your continued cooperation in our efforts to improve our EPSDT scores.