CMS Information Collection: Annual EPSDT Participation Report and State Medicaid Moratorium Request Form
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The Centers for Medicare & Medicaid Services is seeking public comment on two information collections under the Paperwork Reduction Act. The first is a revision of the Annual Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Participation Report (CMS-416). This yearly report collects data from states on the number of eligible children receiving screenings, referrals, and dental, hearing, and vision services. It evaluates how effectively state Medicaid programs meet EPSDT participation goals. The second is a revision of the Initial Request for State Implemented Moratorium Form (CMS-10628). This form standardizes the process for states to request federal approval to impose temporary moratoria on Medicaid or CHIP provider enrollment in specific areas or provider types when fraud or abuse risks are high. Comments must be received by the OMB desk officer by May 6, 2026.
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Key Changes
- Annual EPSDT report (CMS-416) requires data submission from 56 states/territories each year
- EPSDT report tracks screening, diagnostic, treatment, dental, hearing and vision services by age and eligibility basis
- Moratorium request form (CMS-10628) standardizes prior notification to CMS before imposing state Medicaid/CHIP enrollment moratoriums
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Obligations
What this law requires
State Medicaid agencies must submit the Annual EPSDT Participation Report (CMS-416) yearly, reporting data on the number of eligible children receiving screenings, referrals, and dental, hearing, and vision services.
State Medicaid agencies must obtain written approval from the CMS Secretary before implementing any temporary moratorium on Medicaid or CHIP provider enrollment in specific areas or provider types.
States and territories requesting a Medicaid or CHIP moratorium must submit the Initial Request for State Implemented Moratorium Form (CMS-10628) with all details of the proposed moratorium to CMS.
States must provide justification for moratorium requests documenting fraud or abuse risks in the specific areas or provider types subject to the proposed moratorium.
CMS must use the standardized CMS-10628 form as the uniform method to collect and track all state-imposed Medicaid and CHIP moratorium requests.