DHS 107.21(3)(c)(c) Impotence devices and services, including but not limited to penile prostheses and external devices and to insertion surgery and other related services;

DHS 107.21 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. (1) (c) 3., (3), r. (1) (d) 4., renum. (1) (d) 5. to 8. to be (1) (d) 4. to 7; Register, January, 1997, No. 493, eff. 2-1-97.

DHS 107.22(1)(1) Covered services. Early and periodic screening and diagnosis to ascertain physical and mental defects, and the provision of treatment as provided in sub. (4) to correct or ameliorate the defects shall be covered services for all recipients under 21 years of age when provided by an EPSDT clinic, a physician, a private clinic, an HMO or a hospital certified under s. DHS 105.37.

DHS 107.22(2)(2) EPSDT health assessment and evaluation package. The EPSDT health assessment and evaluation package shall include at least those procedures and tests required by 42 CFR 441.56. The package shall include the following:

DHS 107.22(2)(e)(e) Dental assessment and evaluation services furnished by direct referral to a dentist for children beginning at 3 years of age;

DHS 107.22(3)(3) Supplemental tests. Selection of additional tests to supplement the health assessment and evaluation package shall be based on the health needs of the target population. Consideration shall be given to the prevalence of specific diseases and conditions, the specific racial and ethnic characteristics of the population, and the existence of treatment programs for each condition for which assessment and evaluation is provided.

DHS 107.22(4)(4) Other needed services. In addition to diagnostic and treatment services covered by Wisconsin MA under applicable provisions of this chapter, any services described in the definition of “medical assistance” under federal law, 42 USC 1396d(a), when provided to EPSDT patients, are covered if the EPSDT health assessment and evaluation indicates that they are needed. Prior authorization under s. DHS 107.02 (3) is required for coverage of services under this subsection.

DHS 107.22(5)(5) Reasonable standards of practice. Services under this section shall be provided in accordance with reasonable standards of medical and dental practice determined by the department after consultation with the medical society of Wisconsin and the Wisconsin dental association.

DHS 107.22(6)(6) Referral. When EPSDT assessment and evaluation indicates that a recipient needs a treatment service not available under MA, the department shall refer the recipient to a provider willing to perform the service at little or no expense to the recipient’s family.

DHS 107.22(7)(7) No charge for services. EPSDT services shall be provided without charge to recipients under 18 years of age.

DHS 107.22 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. am. (4) (intro.), r. (4) (a) and (b) eff. 4-30-07; CR 07-041: am. (4) (intro.), r. (4) (a) and (b) Register December 2007 No. 624, eff. 1-1-08; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 107.23(1)(1) Covered services.

DHS 107.23(1)(a)(a) Purpose. Transportation by ambulance, specialized medical vehicle (SMV) or county-approved or tribe-approved common carrier as defined under par. (d) 1., is a covered service when provided to a recipient in accordance with this section.

DHS 107.23(1)(b)(b) Transport by ambulance. Ambulance transportation shall be a covered service if the recipient is suffering from an illness or injury which contraindicates transportation by other means, but only when provided:

DHS 107.23(1)(b)1.1. For emergency care, when immediate medical treatment or examination is needed to deal with or guard against a worsening of the recipient’s condition:

DHS 107.23(1)(b)1.a.a. From the recipient’s residence or the site of an illness or accident to a hospital, physician’s office, or emergency care center;