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

   1. (1) Comprehensive and age-appropriate medical assessments and screenings of a child’s physical and mental status in accordance with the American Academy of Pediatrics’ 2023 periodicity schedule entitled “Recommendations for Preventive Pediatric Health Care”, available as noted in Appendix A, including:

      1. a. Comprehensive health and developmental history;
      2. b. Comprehensive unclothed physical examination;
      3. c. Developmental and behavioral assessment with a standardized validated tool of the provider’s choice;
      4. d. Measurements of the child’s height, weight, head circumference, and blood pressure;
      5. e. Appropriate immunizations;

      6. f. Appropriate laboratory tests to include:

         1. 1. Testing for lead toxicity for EPSDT eligible children at 12 and 24 months of age; and
         2. 2. Testing for lead toxicity for EPSDT eligible children between 36 and 72 months of age, if not previously screened for lead toxicity;
      7. g. Appropriate vision testing;
      8. h. Appropriate hearing testing;
      9. i. Assessment of nutritional status;
      10. j. Health education about the benefits of healthy lifestyles and practices; and
      11. k. Anticipatory guidance about child safety and injury prevention; and
   2. (2) Dental screening services furnished by direct referral to a dentist for diagnosis and treatment, and in accordance with the periodicity schedule contained in the American Academy of Pediatric Dentistry’s “Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents” (2022 revision), available as noted in Appendix A.
2. (b) The department shall cover EPSDT diagnostic and treatment services, if medically necessary as a result of assessment and screening.
3. (c) Any services not listed in He-W 522 through He-W 589 as covered services, including experimental or investigational services which are medically necessary and given prior authorization, shall be given independent review by the department for coverage based on medical necessity in accordance with He-W 546.06.

4. (d) Transportation services, pursuant to He-W 574, 42 CFR 431.53, and 42 CFR 441.62, shall be covered:

   1. (1) For EPSDT-eligible children;
   2. (2) For any person who needs to accompany an eligible child to the child’s medical service; and
   3. (3) If a child is receiving residential or facility-based care, for a parent, family member, or caregiver if their presence is necessary to actively participate in the treatment or intervention for the direct benefit of the child, without the child present.
5. (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.

Source. (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; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35