The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service is Medicaid's comprehensive preventive child health service (medical, dental, and case management) for individuals from birth through 20 years of age. EPSDT was created by the 1967 amendments to the federal Social Security Act and defined by the Omnibus Budget Reconciliation Act of 1989. In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components, or Early and Periodic Screening, of the total EPSDT service. In addition, medically necessary health-care services listed in the Act are provided to children and adolescents enrolled in Texas Health Steps even if the service is not available under the state's Medicaid plan to the rest of the Medicaid population. These additional services, particular to Texas Health Steps, are available through the Comprehensive Care Program.
The Texas Medical Assistance (Medicaid) Program was implemented September 1, 1967, under the provisions of Title XIX of the Federal Social Security Act and Chapter 32 of the Texas Human Resources Code. The cost of Medicaid is shared by the State of Texas and the federal government. The Texas Health and Human Services Commission, the single state Medicaid agency, is responsible for the Title XIX Program. The administration of the program is accomplished through contracts and agreements with medical providers, claims administrators (claims reimbursement processor), enrollment brokers, various managed care organizations, and state agencies including the Department of State Health Services. Medicaid providers, including those providing Texas Health Steps services, are reimbursed for their services through contracts with health-insuring contractors, fiscal agents, or direct vendor payments.
Texas Health Steps focuses on the medical, dental, and case management services for ages birth through 20, and is dedicated to:
- Expanding recipient awareness of existing medical, dental, and case management services through outreach and informing efforts.
- Recruiting and retaining a qualified provider pool to assure the availability of comprehensive preventive medical, dental, and case management services.
HHSC administers Texas Health Steps under funding from Title XIX of the Social Security Act for early and periodic screening, diagnosis and treatment services for children from birth through 20 years old who have Medicaid. All Health Service Regional offices have provider relations staff (PDF) to help operate Texas Health Steps statewide.
Texas Health Steps operates under provisions in the Social Security Act, § 1905, and the Consent Decree requirements resulting from Frew, et al. v. Smith, et al. Texas Health Steps is authorized under the regulations of the:
- Texas Medicaid Provider Procedures Manual
- Texas Health Steps Medical and Dental Rules - Texas Administrative Code (TAC), Title 25, Part 1, Chapter 33, Subchapters A through F
- Code of Federal Regulations, Title 42, Chapter IV, § 441.50
- Texas Administrative Code (TAC), Title 1, Part 15, Chapter 353, Subchapters A through H
Several additional legislative requirements affect Texas Health Steps and the participating providers. These include, but are not limited to, the following:
- Newborn Blood Screening, Health and Safety Code, Title 2, Subtitle B, Chapter 33, Sec.A33.001
- Accompaniment of a child younger than 15 years of age, Texas Human Resources Code, Title2, Chapter 32, §§32.024(s)–(s-1); and Texas Administrative Code (TAC), Title 25, Part 1, Chapter 33, Subpart A, §33.2(1) and §33.6(7)
- Requirements for Reporting Abuse or Neglect, as outlined in Chapter 261 of the Texas Family Code, relating to investigations of reports of child abuse and neglect
- Simplified Enrollment, Texas Human Resources Code, §32.025
- Early Childhood Intervention (ECI), Code of Federal Regulations (CFR), Title 34, Chapter III, Part 303; Texas Human Resources Code, Chapter 73; and Texas Administrative Code, Title 40, Part 2, Chapter 108
- Newborn Hearing Screening, Health and Safety Code, Chapter 47
Recruiting and Retaining a Qualified Provider Pool
Medical, dental, and case management and other providers are the cornerstone to making sure that young people in Texas receive Texas Health Steps services at an early age and on a regular basis. Texas Health Steps is committed to recruiting and retaining qualified providers to assure that comprehensive preventive health, dental, and case management services are available. Providers performing medical, dental, and case management services who wish to be eligible for reimbursement for providing Medicaid and Texas Health Steps services must enroll in these programs through the Texas Medicaid and Healthcare Partnership.
The following provider types may provide Texas Health Steps preventive services within his or her individual scope of practice:
- Pediatric and general dentists (DDS or DMD)
- Physician or physician group (MD or DO)
- Physician assistant (PA)
- Clinical nurse specialist (CNS)
- Nurse practitioner (NP)
- Certified nurse-midwife (CNM)
- Federally Qualified Health Center (FQHC)
- Rural Health Clinic (RHC)
- Health-care provider or facility with physician supervision including but not limited to a:
- Community-based hospital and clinic
- Family planning clinic
- Home health agency
- Local or regional health department
- Maternity clinic
- Migrant health center
- School-based health center
In the case of a clinic, a physician is not required to be present at all times during the hours of operation unless otherwise required by federal regulations. A physician must assume responsibility for the clinic's operation.