Name: Christopher M. Maestas, SHRM-SCP SPHR

Title: General Manager, AMI-Wellness Home Health

Project: 8.11 - Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Benefits Training

Project Background: To ensure the best use of services potentially available to the HCBS population, the Department will develop training on quality performance measures with a focus on Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit metrics. The team will use an analysis of EPSDT to illuminate current gaps in the HCBS program. The analysis will be used to create training materials that will include specific learning objectives on how and when to use EPSDT and how and when to use HCBS services. To the extent this analysis exposes policy gaps, this information would be used to inform policy and program adjustments. These trainings will also be used to assist the state to meet the federal requirement of an intersection of EPSDT and waiver services as outlined in the CMS Part V Manual. 

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I have worked in home health care for the last 20 years. We serve a variety of different families, and children with disabilities and special needs have always been one of our core constituencies. I have been fortunate enough to work on many projects with HCPF, including the Benefits Collaborative, and initiatives like standardizing the pediatric assessment tool. I was glad to join when an opportunity came up to serve on the Children's Services Steering Committee. The committee works extremely hard to ensure that we find and deliver funding and services for Colorado's neediest citizens while still being good stewards of taxpayer funds. Since the committee members are active provider stakeholders, we can often bring common-sense policy changes to the Department to make things better for everyone involved. For several years, it has been clear that the benefits available under the EPSDT program are not well understood, and misinformation can cause people to miss out on services to which they are entitled. I am excited to see the benefits training project outreach to the people who can really use the available assistance.

All EPSDT benefits go through review and suggestions from the committee. Almost everything the committee works on is related to EPSDT benefits. Generally, our topics are split between coverage-type questions and provider relations and advice questions. Issues surrounding a particular type of benefit or a challenge faced by a family or provider - these things end up on the committee's agenda. Standardizing processes and improving access and education about benefit availability are always at the top of our list.

Because EPSDT programs are often wide-ranging, providers can sometimes get lost in what is covered and what would be best accessed through a different avenue. The training modules that are the most enjoyable and exciting for us are the ones where we can help families access benefits and allay fears and concerns from providers about reimbursement by assisting them in navigating through the EPSDT systems.

Most times, once a provider understands how to access the reimbursement, they go full speed ahead to open up access to these benefits to as many of their consumers as they can. The goal for everyone in the community that works around these programs is to increase access and increase positive outcomes for the children we serve.

Many of the Department programs, not just EPSDT, are subject to federal guidance and regulation. Like anything in government, changes to these programs occur, and ongoing provider education is vital to maintain access for consumers and families. One of the most important things we do is make sure that providers understand what guideline changes may be occurring. Providers can have time to adjust their service delivery and access to benefits accordingly. Proactive training allows providers to continue to provide needed services with a minimum of disruption from a rule change. Ongoing provider outreach and education are vital to maintaining a robust network for Health First Colorado members.