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Welcome  » March 28, 2024 7:29 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: HealthCheck (EPSDT)
03/28/2024  

Covered and Noncovered Services : HealthCheck "Other Services"

Topic #22

Definition of HealthCheck "Other Services"

HealthCheck is the term used for EPSDT in Wisconsin. The HealthCheck benefit provides periodic, comprehensive health screening exams (also known as "well child checks"), as well as interperiodic screens, outreach and case management, and additional medically necessary services (referred to as HealthCheck "Other Services") for members under 21 years of age.

Wisconsin Medicaid covers most diagnostic and intervention services a member may need. However, federal law requires that states provide any additional health care services that are coverable under the federal Medicaid program and found to be medically necessary to treat, correct, or reduce illnesses and conditions discovered regardless of whether or not the service is covered in a state's Medicaid program. HealthCheck "Other Services" is Wisconsin's term for this federal requirement.

The requested service must be allowable under federal Medicaid law, per § 1905(a) of the Social Security Act, and must be medically necessary and reasonable for the member to be covered by Wisconsin Medicaid, per Wis. Admin. Code § DHS 107.02(3)(e). Most HealthCheck "Other Services" require PA per Wis. Admin. Code § DHS 107.02.

 
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