The mission of the Maryland Healthy Kids/EPSDT Program is to ensure access and availability of quality health care for HealthChoice-enrolled children, teens, and young adults less than 21 years of age.[1] The EPSDT program in Maryland has been conducted by the Maryland Department of Health (MDH) since 2007. Maryland’s EPSDT program requires all primary care providers (PCPs) to provide HealthChoice-enrolled children and adolescents through 20 years of age with timely screening and preventative care according to the Maryland Schedule of Preventative Health Care standards.
Per federal regulations, the MDH must contract with an external quality review organization (EQRO) to conduct annual, independent reviews of Maryland’s HealthChoice program. The MDH contracts with Qlarant to perform these annual reviews which include an annual assessment of each individual managed care organizations (MCO) compliance with timely delivery of EPSDT services to children and adolescents who are enrolled with the HealthChoice MCO.
Each year, Qlarant completes an annual EPSDT medical record review to ensure HealthChoice MCOs meet the MDH-established minimum compliance threshold of 80% for the following components: Health and Developmental History; Comprehensive Physical Examination; Laboratory Tests/At-Risk Screenings; Immunizations; and Health Education/Anticipatory Guidance.
MedStar Family Choice results for Measurement Year (MY) 2021:
In MY 2021, MFC’s total composite score increased three percentage points from MY 2020 (90%) to MY 2021 (93%) and equaled the MY 2021 HealthChoice Aggregate score.
- 95% in Health and Development History
- 96% in Comprehensive Physical Exam
- 82% in Laboratory Test/At-Risk Screenings
For more detailed audit findings, a copy of the 2022 EPSDT Statewide Executive Summary can be found by clicking here.
[1] Maryland Department of Health. (n.d.) Early Periodic Screening Diagnosis and Treatment. Retrieved from https://health.maryland.gov/mmcp/epsdt/pages/home.aspx
Information current as of: