CMS-416 EPSDT Reporting
CMS_416free10 data-quality rules for the annual CMS-416 EPSDT (Early and Periodic Screening, Diagnostic and Treatment) report submitted by state Medicaid agencies to CMS. Covers required state/period identification, valid age groups, non-negative eligible and screened counts, screening-ratio bounds, population reconciliation, and duplicate suppression. Use it to validate the CMS-416 before submission.
Checks included (10)
Screened Does Not Exceed Eligible
The number screened cannot exceed the number eligible in an age group.
Referrals Do Not Exceed Screened
The number referred for corrective treatment cannot exceed the number screened.
Dental Services Do Not Exceed Eligible
The count receiving any dental service cannot exceed the eligible population.
Required Report Fields Present
Each line must carry the reporting state, federal fiscal year, and age group.
Federal Fiscal Year Present(federal_fiscal_year)
The federal fiscal year must be present on every line.
Eligible Counts Are Non-Negative(total_eligibles)
Counts of individuals eligible for EPSDT cannot be negative.
Screening Ratio Between 0 and 1(screening_ratio)
The screening ratio (screened / eligible) must fall between 0 and 1.
Age Group Is Valid(age_group)
Age group must be one of the CMS-416 categories (<1, 1-2, 3-5, 6-9, 10-14, 15-18, 19-20).
State FIPS Is Valid
The reporting state must be a valid state FIPS code.
One Line per State / Year / Age Group(line_key)
Each state + fiscal year + age group should appear once.