1. 1 EPSDT: Early and Periodic Screening, Diagnosis and Treatment Program Presenter: Diana M. Straube National Assistive Technology Advocacy Project, Neighborhood Legal Services

2. 2 Medicaid covers DME that: can withstand repeated use are primarily and customarily used for medical purposes are generally not useful in the absence of an illness or injury usually not fitted, designed or fashioned for a particular individual’s use.

3. 3 Equipment may also be covered under physical therapy occupational therapy speech pathology services rehabilitation prosthetics orthotics, etc.

4. 4 Medical Necessity Prevent, diagnose, correct or cure a condition that: causes acute suffering endangers life results in illness or infirmity interferes with the capacity for normal activity threatens to cause a significant handicap

5. 5 EPSDT: comprehensive and preventative health care program for recipients under 21 early and periodic screening and diagnosis to ascertain physical or mental defects such health care, treatment or other measures to correct or ameliorate defects and chronic conditions broadens definition of medical necessity

6. 6 Medicaid must provide: Outreach and informing Screening Diagnosis Treatment Adequate provider participation Reporting

7. 7 EPSDT screenings (assessments) must include: Gross and fine motor development Communication skills or language development Self-help or self-care skills Social-emotional development Ability to engage in social interaction Cognitive skills, focusing on problem solving or reasoning

8. 8 As children age, assessments should include: Visual-motor integration Visual-spatial organization Visual sequencing processing skills Auditory sequential memory

9. 9 Assessments of adolescents should include: Identification of potential learning disabilities Peer relations Psychological/psychiatric problems Vocational skills

10. 10 Matter of J.P., NY FH # 3689971R Sip-and-puff mechanism for wheelchair was necessary to: maximize child’s opportunity for cognitive development allow him to be more responsible for own self- care and safety foster his learning capacity foster his general ability to explore his environment “as is necessary for any child his age”

11. 11 Matter of John, NY FH # 4337314K Medicaid denied prior approval for power wheelchair for young child, claiming child always had a caregiver present who could push him. Decision rejected agency’s argument that continued reliance on caregivers to push him would be developmentally inappropriate for child.

12. 12 Following services are available if medically necessary: computers, such as the Apple II Computer with printers, computer software exercise equipment including exercise bikes, swing sets, and tricycles communication devices such as the Dynavox specialized eating utensils and other daily living aids