Health Care Financing Administration 7500 Security Blvd., Baltimore, MD. 21244-1850

99 -- EPSDT SERVICES IN STATE MEDICAID PLANS AND MEDICAID MANAGED CARE CONTRACTS POC Lucille Fussell-Lee, Contract Specialist (410) 786-5447 The Health Care Financing Administration (HCFA) intends to award on a sole source basis, under the Simplified Acquisition Procedures an award to the Center for Health Services Research and Policy, George Washington University, 2021 K Street, N.W., Suite 800, Washington, DC 20006. This project is to provide HCFA with sufficient data on State Medicaid programs to allow the Agency to estimate the costs associated with EPSDT services that are over and above what Medicaid costs would be in the absence of the enhanced EPSDT service benefit. The work to be performed will include a series of five tables with accompanying memoranda that summarize the research findings. Four of the tables will present national findings for all State Medicaid programs; the fifth table will present findings from an analysis of State Medicaid plans from 25 States. The selected 25 States are those which are included in HCFA's analyses of the 1995 State Medicaid Research Files (SMRF) database. The Center for Health Services Research and Policy (CHSRP) at the George Washington University of School of Public Health and Health Services is uniquely qualified to assist HCFA in an analysis of the medical necessity standard under EPSDT. Since 1995, CHSRP has conducted an intensive examination of contracts between State Medicaid agencies and MCOs. The analytic work has produced two editions of a comprehensive study of contract provisions. The most recent version is the five volume document. Negotiating the Health System: A Nationwide Study of Medicaid Managed care Contracts (2nd Ed. 1998). The third edition will be released in July 1999. This report specifically examines EPSDT in Table 24 and Medical Necessity Standards in Table 2.7. These contract provisions will show how States are defining the EPSDT medical necessary standard in contracts. To date, CHSRP has the most comprehensive collection of contract documents and a searchable database of contractual provisions. In addition, CHSRP is widely known for its work on medical necessity and coverage determination standards. CHSRP also has extensive experience in other studies comparing State policies in a variety of areas, and has contacts with every State Medicaid office. All responsible sources may submit capability statements in consideration to the agency at the above address. Posted 07/09/99 (I-SN352406). (0190)

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