Managed Care Contract Provisions—Beefing Up EPSDT During Contract Renegotiations

Executive Summary

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is a mandatory and essential part of states’ Medicaid programs. As such, it needs to be thoroughly defined and detailed in state Medicaid managed care contracts. NHeLP maintains a bank of managed care contracts. NHeLP recently reviewed a select sample of current managed care contracts in search of good examples of EPSDT contract provisions. The provisions excerpted in this memo are examples of language that can be suggested, as appropriate and with needed modifications, when states are renegotiating their managed care contracts.