Department of Nursing, 16166The University of Tennessee Knoxville College of Nursing, Knoxville, TN, USA.
Pediatric Palliative Care, 12284University of Nebraska Medical Center, Omaha, NE, USA.
Am J Hosp Palliat Care. 2022 Dec;39(12):1460-1466. doi: 10.1177/10499091221079329. Epub 2022 Mar 31.
Medicaid is the most common of health care benefits for children at end of life. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) presents a complex policy scenario for children enrolled in the Medicaid hospice benefit, and specifically concurrent hospice care. The study purpose was to identify policy guidance on EPSDT and pediatric hospice care from state Medicaid documents. We conducted a descriptive exploratory study, using state-level Medicaid hospice documents. Manuals, policy transmittals, provider memos, policy updates, and other related documents were searched from 50 states and the District of Columbia. We created a comprehensive data extraction tool that enabled us to identify EPSDT-specific information. The appraisal of the documents was conducted under 3 main a priori themes: definitions, function, and administration. Eleven states included EPSDT in their hospice documentation. Definitions for concurrent care and palliative care were sparse and inconsistent. Four states defined medically necessary criterion. Several states did not integrate EPSDT into the hospice or concurrent care benefit, while EPSDT functioned as part of the Medicaid hospice benefit in 3 states and another 4 included it in their concurrent hospice care program. Among all the states, procedures for EPSDT program administration varied widely, including care coordination and payment. We found significant variation in state documents on EPSDT and pediatric hospice care. Clear guidelines and consistent standards regarding EPSDT services and how they interface with hospice, concurrent hospice care, and palliative care would improve care for children and families.
医疗补助是末期儿童最常见的医疗福利。早期和定期筛查、诊断和治疗（EPSDT）为参加医疗补助临终关怀福利的儿童，特别是同时接受临终关怀护理的儿童，带来了复杂的政策情况。本研究旨在从州医疗补助文件中确定有关 EPSDT 和儿科临终关怀护理的政策指导。我们进行了一项描述性探索性研究，使用了州级医疗补助临终关怀文件。从 50 个州和哥伦比亚特区搜索了手册、政策传输、提供者备忘录、政策更新和其他相关文件。我们创建了一个综合的数据提取工具，使我们能够识别特定于 EPSDT 的信息。根据 3 个主要先验主题对文件进行评估：定义、功能和管理。11 个州在其临终关怀文件中纳入了 EPSDT。关于同时护理和姑息治疗的定义很少且不一致。有 4 个州定义了医疗必需标准。有几个州没有将 EPSDT 纳入临终关怀或同时护理福利中，而在 3 个州，EPSDT 作为医疗补助临终关怀福利的一部分运作，另外 4 个州将其纳入了同时进行的临终关怀护理计划。在所有州中，EPSDT 计划管理程序差异很大，包括护理协调和付款。我们发现州文件中关于 EPSDT 和儿科临终关怀护理的差异很大。明确的指南和一致的标准，关于 EPSDT 服务以及它们如何与临终关怀、同时进行的临终关怀护理和姑息治疗接口，将改善儿童和家庭的护理。
