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Interaction Between EPSDT and Pediatric Concurrent Hospice Care: Improving Access, Cost, and Quality of Care

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by Lisa C. Lindley, PhD, RN, FPCN, FAAN

March 2025

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program is a Medicaid benefit that ensures children under the age of 21 receive comprehensive and preventive health care services. This program can play a crucial role in enhancing access, reducing costs, and improving the quality of care for children receiving pediatric concurrent hospice care. Here’s how EPSDT can be leveraged to achieve these goals.

Enhancing Access to Care

1. Comprehensive Coverage:

  • Broad Range of Services: EPSDT covers a wide array of services including screenings, diagnostics, and treatments necessary to correct or ameliorate defects and physical and mental illnesses. This ensures that children receiving concurrent hospice care have access to all medically necessary services without delay.
  • Early Intervention: By providing early and periodic screenings, EPSDT helps in the early identification of health issues, allowing for timely interventions which are crucial for children with life-limiting conditions.

2. Removing Barriers:

  • No Cost Sharing: EPSDT eliminates cost-sharing barriers for families, ensuring that financial constraints do not hinder access to necessary care.
  • Transportation Services: The program includes transportation assistance to medical appointments, which is particularly beneficial for families who might struggle with logistics.

Reducing Costs

1. Preventive Care:

  • Cost Savings through Prevention: By focusing on preventive care and early treatment, EPSDT can help reduce the need for more expensive emergency or inpatient care. This is especially important for children with complex medical needs who are receiving concurrent hospice care.
  • Avoiding Hospitalizations: Regular monitoring and timely interventions can prevent complications that might otherwise lead to costly hospitalizations.

2. Coordinated Care:

  • Integrated Services: EPSDT promotes coordinated care among various healthcare providers, ensuring that all aspects of a child’s health are managed efficiently. This coordination can lead to better resource utilization and cost savings.
  • Home-Based Services: The program supports home-based care services which are often less expensive than institutional care settings.

Improving Quality of Care

1. Holistic Approach:

  • Comprehensive Health Assessments: EPSDT mandates thorough health assessments that consider physical, emotional, and developmental needs. This holistic approach ensures that all aspects of a child’s well-being are addressed.
  • Individualized Care Plans: Based on the assessments, individualized care plans are developed to meet the specific needs of each child.

2. Continuous Monitoring:

  • Regular Screenings: Continuous monitoring through regular screenings allows for ongoing assessment of the child’s condition and timely adjustments to their care plan.
  • Quality Assurance: EPSDT includes quality assurance measures to ensure that services provided meet established standards of care.

Conclusion

The integration of EPSDT with pediatric concurrent hospice care offers a robust framework for improving access, reducing costs, and enhancing the quality of care for children with life-limiting conditions. By leveraging the comprehensive coverage, preventive focus, and coordinated approach of EPSDT, healthcare providers can ensure that these vulnerable patients receive the best possible care throughout their illness journey.