The mission of the Maryland Healthy Kids/EPSDT Program is to ensure access and availability of quality health care for HealthChoice 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 the following five components: Health and Developmental History; Comprehensive Physical Examination; Laboratory Tests/At-Risk Screenings; Immunizations; and Health Education/Anticipatory Guidance. MedStar Family Choice must receive a total of 80% to pass. MedStar Family Choice received a total score of 90% this year. Our total score is four points higher than last year and one point below the Health Choice Managed Care Organization (MCO) average of 91%.

MedStar Family Choice results for 2021 (CY 2020):

  • 94% in Health and Development History
  • 95% in Comprehensive Physical Exam
  • 73% in Laboratory Test/At-Risk Screenings
  • 85% in Immunizations
  • 94% in Health Education/Anticipatory Guidance 

MFC met the minimum compliance threshold for four out of the five components; however, during the course of their review, Qlarant identified a few opportunities for improvement. MFC needs to enlist the help of our EPSDT certified providers to ensure that the minimum compliance thresholds are met in the following areas: For the Health and Development History component, EPSDT certified providers should be mindful of all the documentation requirements applicable to the Perinatal History and Maternal Depression Screenings. Within the Comprehensive Physical Exam component, providers must also graph head circumference measurements. Additionally, providers should take the time to review the schedules for required lab tests, at-risk screenings, and immunizations to ensure their patients are up to date; in particular, the Dyslipidemia requirement for 9–11-year old’s. 

Please note that MedStar Family Choice EPSDT certified providers are required to follow the MDH Immunization Schedule, and they should ensure that their patients receive the required screening and laboratory tests as outlined in the Maryland HealthChoice Well Child Care Schedule. MFC EPSDT certified providers are also strongly encouraged to use the Maryland Healthy Kids Program’s age-appropriate encounter forms, risk assessment forms, and questionnaires that are designed to assist with documenting preventative services according to the Maryland Schedule of Preventive Health Care.  The Maryland Immunization registry (ImmuNet) is also available as an online resource that can be used to check a child’s immunization history. 

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.

Information current as of: