Rosie D.
Reforming the Mental Health System in Massachusetts

Federal Regulations

Federal regulations governing the EPSDT program are generally set forth in 42 C.F.R.  Part 440.50 et seq (Subpart B).   These regulatory provisions closely mirror the language of the statute, underscoring its focus on prevention and treatment of physical and mental health conditions before they become disabling.  They have not been updated since the late 1980s.  Significantly, the regulations provide no guidance for interpreting critical screening, diagnosis and treatment requirements found at 42 U.S.C. ' 1396a(a)(43).  

Key Medicaid regulations can be found at:


Notice and informing obligations under EPSDT: 42 C.F.R.§  441.56(a) 


Rehabilitative services: 42 C.F.R. §  440.130


Home health care services: 42 C.F.R. § 440.70


Reasonable promptness requirements: 42 C.F.R. § 435.930(a)


States’ obligations to make services available: 42 C.F.R. § 441.61(b)



The Center for Medicaid and Medicare Services (CMS) has proposed new regulations governing rehabilitative services and interim final regulations targeted case management.  Recently, CMS withdrew the most problematic provisions of the TCM rules and suspended the rule-making process for the rehabilitative services rules.


Proposed regulations are published in the Federal Register, August 13, 2007, Vol. 72, No. 155, 45201-45213 (rehabilitative services) and December 4, 2007, Vol 72, No. 232.68977-68093; 42 CFR Parts 431, 440 and 441 (case management).  More information on the promulgation of these rules, a discussion of their impact on Medicaid recipients and model comments can be found at the Bazelon Center for Mental Health Law (


The State Medicaid Manual, which contains federal policies and directives applicable to the entire Medicaid program, includes a chapter on requirements for the EPSDT program (Chapter 5). 


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