KanCare MCOs may provide in lieu of services, which are medically appropriate and cost-effective services or settings to those covered under the State Plan, if prior approved by the State. To receive approval of an in lieu of service, the KanCare MCOs shall perform a cost-benefit analysis for any in lieu of service or setting it proposes to provide, including how the proposed service would be a medically appropriate and cost-effective substitute for a covered service. KanCare MCOs may not require a member to receive an in lieu of service instead of a covered service. Approved in lieu of services are offered to members at the option of the KanCare MCOs. If the State approves the in lieu of service, the State will consider the utilization and actual cost for the in lieu of service in rate setting, unless otherwise prohibited by Federal law.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidance requires Kansas Medicaid to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan for children under the age of 21. These services are considered covered services and are not in lieu of services.
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.
- Early: Assessing and identifying problems early
- Periodic: Checking children's health at periodic, age-appropriate intervals
- Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
- Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and
- Treatment: Control, correct or reduce health problems found.