N.H. Admin. Code § He-W 546.05

Current through Register No. 36, September 5, 2024

Section He-W 546.05 - Covered Services

(a) The department shall cover the following EPSDT screening services:

(1) Comprehensive and age-appropriate medical assessments and screenings of a child's physical and mental status in accordance with the 2014 periodicity schedule entitled "Recommendations for Preventive Pediatric Health Care" of the American Academy of Pediatrics/Bright Futures, available as noted in Appendix A, including:

a. Comprehensive health and developmental history;

b. Comprehensive unclothed physical examination;

c. Developmental and behavioral assessment with a standardized validated tool of the provider's choice;

d. Measurements of the child's height and weight, head circumference, and blood pressure;

e. Appropriate immunizations;

f. Appropriate laboratory tests to include:

1. Testing for lead toxicity for EPSDT eligible children at 12 and 24 months of age; and

2. Testing for lead toxicity for EPSDT eligible children between 36 and 72 months of age, if not previously screened for lead poisoning;

g. Appropriate vision testing;

h. Appropriate hearing testing;

i. Assessment of nutritional status;

j. Dental screening services furnished by direct referral to a dentist for diagnosis and treatment, and in accordance with the periodicity schedule contained in "Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents" (2013 revision), of the American Academy of Pediatric Dentistry, available as noted in Appendix A;

k. Health education about the benefits of healthy lifestyles and practices; and

l. Anticipatory guidance about child safety and injury prevention.

(b) The department shall cover the following EPSDT diagnostic and treatment services, if medically necessary as a result of assessment and screening:

(1) Urinalysis;

(2) Sickle cell screening;

(3) Tuberculin testing;

(4) Blood testing for hematocrit and/or hemoglobin levels;

(5) Immunizations provided in accordance with the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention "Recommended Immunization Schedules for Persons Aged 0 Through 18 Years, United States 2015," available as noted in Appendix A; and

(6) Any other Medicaid services as specified in He-W 522 through He-W 589, to treat conditions discovered during a screen.

(c) Any services not listed in He-W 522 through He-W 589 as covered services shall be given independent review by the department for coverage based on medical necessity in accordance with He-W 546.06.

(d) Transportation services, pursuant to He-W 574, 42 CFR 43.153, and 42 CFR 441.62, shall be covered for EPSDT-eligible children.

(e) Services in excess of the service limits in He-W 530 shall be covered for EPSDT-eligible children, if medically necessary, in accordance with the requirements in He-W 546.06

N.H. Admin. Code § He-W 546.05

(See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98

New. #6940, eff 1-30-99; ss by #8437, eff 9-24-05; ss by #8782, eff 1-1-07; ss by #10829, eff 5-19-15

Amended by Volume XXXV Number 23, Filed June 11, 2015 , Proposed by #10829, Effective 5/19/2015, Expires5/19/2025.