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 the Delmarva Foundation (Delmarva) to serve as the External Quality Review Organization (EQRO). Beginning with calendar year 2007 services, Delmarva began performing an annual medical record review of preventive services performed, according to Maryland’s Schedule of Preventive Health Care for HealthChoice children under the age of 21.
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 percent is required for each component. For 2017 (based on review of calendar year 2016 medical records), the composite score for MedStar Family Choice was 91 percent (an increase by one percent), which equaled the statewide overall HealthChoice Composite score of 91 percent.
MFC scored above 80 percent in all five components. Areas in which the MedStar Family Choice scored above, equaled or met the HealthChoice Aggregate score are: Comprehensive Physical Exam and Immunizations.
It is important to note that when MedStar Family Choice providers follow the MDH Immunization Schedule and the schedule for performing the required laboratory tests as identified in the Maryland HealthChoice Well Child Care Schedule, they utilize the age-specific EPSDT forms and Preventive Screen Questionnaire. The nurse reviewers can easily assess the timely delivery of EPSDT services to children and adolescents enrolled in a Managed Care Organization (MCO). This should help improve your audit results, as well as that of MFC. MDH makes helpful forms available for use by providers on their website at: https://mmcp.health.maryland.gov/epsdt/healthykids/Pages/Encounter-Forms.aspx.
We recommend and encourage our providers to include documentation in the medical record of: Initial Family History, Update to Family History, Well Child Encounter Form, Growth Chart and Graphic Sheet, Risk Assessment/ Screen Questionnaire, Copy of Labs/Lab Referrals, Newborn Screening Results and Vaccine/Immunization Record in order to support the EPSDT services that were rendered.
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 you for your continued cooperation.