SECTION 340:70-9-2. Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

(a)   Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a preventive health program under the SoonerCare Program that provides for comprehensive medical services to SoonerCare recipients under 21 years of age. It helps identify and treat physical, mental, or emotional illnesses or conditions in order to prevent or reduce human suffering and economic loss.

(1)   EPSDT services consist of physical, dental, visual, or hearing screening, family planning, and assessment services and include the provision of recommended treatment and diagnostic services.

(2)   Recipients may receive initial and periodic screening examinations at no cost, provided they continue to be eligibile for SoonerCare.

(3)   The initial screening may be obtained any time during the recipient's period of eligibility.

(4)   The recipient uses the provider of his or her choice within the confines of the Oklahoma Health Care Authority's (OHCA) provider network. If the recipient does not know of a provider, the worker assists in locating one.

(5)   See OAC 340:70-9-17 for information about family planning.

(b)   Recipients who receive EPSDT screenings are eligible for all recommended treatment and diagnostic services:

(1)   within the scope of the SoonerCare Program; and

(2)   beyond the scope of the SoonerCare Program when the services are pre-authorized by OHCA. The scope of the SoonerCare Program is detailed in OAC 317.

(c)   The local human services center (HSC) worker is responsible for identifying and documenting EPSDT services and offering support services. Support services include identifying and resolving any existing barriers to the utilization of EPSDT services.

(1)   The worker offers all recipients requesting EPSDT support services assistance in arranging appointments for screening examinations. The worker involves the recipient to the greatest extent possible in the process of arranging appointments for screening.

(2)   If lack of transportation is identified as a barrier, the worker assists the recipient in exploring family, neighborhood, and community resources. When appropriate, the worker refers the recipient to SoonerRide, community service groups, or arranges for the services of an Oklahoma Department of Human Services (OKDHS) volunteer, or other staff to meet the need.

(3)   If immunizations are not current for children in the family, the worker discusses the importance of keeping immunizations current. The family is also informed that state law requires all children in child care and/or public school to have current immunizations unless exempt for health or religious reasons. The worker recommends that the children make an appointment with their SoonerCare provider or other appropriate local resources to obtain immunizations.

(d)   Medical providers of EPSDT services may include physicians, dentists, optometrists, psychologists, clinics, hospitals, child health centers, local health departments, and school districts.

[Source: Amended at 11 Ok Reg 825, eff 12-14-93 (emergency); Amended at 11 Ok Reg 1705, eff 5-12-94; Amended at 19 Ok Reg 1785, eff 6-14-02; Amended at 24 Ok Reg 2191, eff 7-1-07]