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Special Health Issues
What the MCOs Report to DHCF
MCOs must report the following to DHCF:
What DHCF Reports to the Federal Government
DHCF must report to CMS, by April 1 of each year, health screening information using Form CMS 416 (PDF) for children participating in the managed care and fee-for service programs for the year ending September 30 of the previous year.
This data allows the federal government to analyze and compare the delivery of EPSDT services in the states.
The Role of the Primary Care Physician in the Reporting Process
The PCP must report certain data to the MCO to enable it to make required reports to DHCF.
DC's fiscal agent is responsible for reporting fee-for-service provider EPSDT procedure code data on or before March 1 of each year for inclusion in the annual CMS 416 Report.
The role of the PCP in documenting and reporting EPSDT services is crucial!