469 NAC 5-002.01
The worker must inform the client of HEALTH CHECK (EPSDT) at the time of application and redetermination. The worker must accomplish this by giving the client:
1. A verbal explanation of HEALTH CHECK (EPSDT), including a review of the HEALTH CHECK (EPSDT) pamphlet;
2. A pamphlet explaining HEALTH CHECK (EPSDT); and
3. The opportunity to ask questions.
Special emphasis is to be placed on informing for first time eligibles, mothers and families with infants or adolescents, or those not participating for over two years, or other eligible children considered 'at risk' for health care. A Medicaid-eligible woman's positive response to an offer of HEALTH CHECK (EPSDT) services during her pregnancy constitutes a request for services for the child at birth. For a child eligible at birth, the request for HEALTH CHECK (EPSDT) services is effective with the birth of the child.
These informing procedures are to be adapted to meet the needs of persons who are illiterate, blind, deaf, or who cannot understand the English language.
In addition, notifications are sent to clients informing them of when they are due for health and dental exams according to the periodicity schedule. All Claims Inquiry (CICS1, Selection 17) is a resource for the eligibility worker to determine when the last screening examination was covered by Medicaid.
For those families requesting HEALTH CHECK (EPSDT) and also requesting support services, the worker must provide assistance or refer to the appropriate unit for assistance in arranging transportation, locating a doctor, dentist or other screening practitioner, or setting appointments. If the client has entered into a continuing care formal agreement, the continuing care provider may be responsible for some or all of the support services and follow-up (see 471 NAC 33-002.07A). For wards, see 471 NAC 41-004.