Provider Index > Children's Health and Behavioral Transformation
Provider Enrollment & Maintenance
Childrens BH Early and Periodic Screening and Diagnostic Testing (EPSDT), formerly known as SPA Services, are Behavioral Health and Health services available to children/youth under the age of 21 who are Medicaid eligible and meet medical necessity criteria. Applicants must meet the provider qualifications as specified in the Manual and will be designated by the State.
Children's Home and Community Based Services (HCBS) are designed to offer Medicaid eligible children/youth under the age of 21 who meet the target, risk and functional criteria, and their families, services and supports in the least restrictive environment to enable them to remain at home and in the community. Applicants must meet the provider qualifications as specified in the HCBS Manual and will be designated by the State.
Complete this Enrollment Form if you are:
- Applying for initial ENROLLMENT or ALREADY ENROLLED and enrolling another NPI, or
- Responding to a letter instructing you to REVALIDATE your enrollment, or
- Seeking REINSTATEMENT or REACTIVATION of your previous enrollment, or
- Reporting an OWNERSHIP CHANGE, or
- Reporting a RECEIVERSHIP
INSTITUTION Enrollment Form