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Early Periodic Screening Diagnosis Treatment (EPSDT)-Part 2

Reminder to all providers treating patients under 21 who have OHA.

Oregon did not renew the longstanding waiver around EPSDT for children. The decision comes as a result of clear feedback from the community, advocates, children's service organizations, and other interested parties. Beginning January 1, 2023, OHA and CCOs must cover services below the funding line on the Prioritized List of Health Services for OHP members under age 21 when medically necessary and medically appropriate. Medical necessity and medical appropriateness are determined on a case-by-case basis, taking into account the member's needs.

States must cover all medically necessary and medically appropriate services that are part of the federal EPSDT benefit, even if the service is not available or defined under the state's Medicaid plan.

The federal EPSDT benefit for covered screening aligns with Bright Futures – American Academy of Pediatrics. If recommended in accordance with Bright Futures guidelines then it will be covered. Authorizations will still be required in accordance with the current Cascade Health Alliance auth grid.

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