Covered and Noncovered Services : Covered Services and Requirements

Comprehensive HealthCheck Screening Components and Periodicity

Required Components for Comprehensive Screens

Comprehensive HealthCheck screens are age-appropriate medical wellness check-ups that occur on a regular basis for Medicaid members under 21 years of age, and include the following components:

• A comprehensive health and developmental history, including:
  • A health history
  • A nutritional assessment
  • A developmental-behavioral assessment
  • Health education and anticipatory guidance for the member and caregiver
• A comprehensive unclothed physical exam
• A hearing screen
• A vision screen
• An oral assessment, plus referral to a dentist beginning when the first tooth erupts or by age 1
• Appropriate immunizations (according to age and health history, per the CDC's ACIP guidelines)
• Appropriate laboratory tests (including blood lead level testing when appropriate for age)

HealthCheck provides access to comprehensive medical, vision, hearing, and dental screens according to the periodicity schedule recommended by the AAP.

As required by 42 C.F.R. § 441.58, Wisconsin Medicaid follows AAP's periodicity schedule for screening services.

Conditions identified during a HealthCheck screen may be referred for additional evaluation, which is covered by Wisconsin Medicaid. These conditions may result in recommendations for services that may be covered as HealthCheck "Other Services."

Accessing Comprehensive Screens

Comprehensive HealthCheck screens are available without PA. Primary care providers, including pediatricians, nurse practitioners, local health departments, and physician clinics, should provide the appropriate components of a HealthCheck screen, based on AAP or other best practice guidelines, as part of a comprehensive well child exam. No special forms are required.

Providers are required to maintain documentation of the HealthCheck screen and all areas that were assessed in the member's medical record. Clinics or agencies may use their own documentation system, or they may use forms available from Wisconsin Medicaid that meet the documentation requirements. These forms are available free of charge.

Note: Medicaid reimbursement is limited to Medicaid-enrolled providers.