Healthchek is Ohio’s EPSDT program. Healthchek is designed to provide comprehensive preventive healthcare services at regular age intervals. Regular EPSDT preventive visits find health issues early (including physical health, mental health, growth, and developmental), so additional testing, evaluation, or treatment can start right away. EPSDT preventive services are available at the recommended ages and at other times when needed.
EPSDT stresses health education to children and their caretakers related to early intervention, health and safety risk assessments at every age, referrals for further diagnosis and treatment of problems discovered during exams, and ongoing health maintenance.
The Humana Healthy Horizons in Ohio Provider Manual, PDF has information about:
- Covered services
- EPSDT preventive exam components
- EPSDT special services
- EPSDT exam frequency
Learn more about Ohio’s Healthchek program
Federal regulation requires that all children receive a blood test for lead at:
- 12 months and 24 months
- 36 months and 72 months for children who have not had a previous blood lead screening
This is a required part of the EPSDT exam provided at these ages.
Additionally, Ohio law requires all healthcare providers to administer blood lead tests to children at ages 1 and 2, or up to age 6 if no previous test has been completed if the child:
- Is on Medicaid
- Lives in a high-risk ZIP code
- Has certain other risk factors
You can find more information on child lead poisoning and high-risk ZIP codes at the Ohio Department of Health Child Lead Poisoning Program website.
Immunizations are an important part of preventive care for children. You should administer immunizations during well-child/EPSDT exams as needed. Humana Healthy Horizons in Ohio endorses the same recommended childhood immunization schedule that the Centers for Disease Control and Prevention recommends.
Annually, Humana will provide Healthchek education to all network contracted providers on an annual basis. This education will include:
- The required components of a Healthchek exam pursuant to OAC rule 5160-01-14
- A list of the intervals at which members under the age of 21 should receive screening examinations, as indicated by the most recent version of the document “Recommendations for Preventive Pediatric Health Care” published by Bright Futures/American Academy of Pediatrics
- A list of common billing codes and procedures related to the Healthchek services, PDF (e.g. immunizations, well-child exams, laboratory tests, and screenings)
You can find additional information at the Ohio Department of Medicaid Healthchek Program website.
The Ohio Department of Medicaid (ODM) implemented OhioRISE (Resilience through Integrated Systems and Excellence), a specialized managed care program for youth with complex behavioral health and multisystem needs.
The OhioRISE Plan
OhioRISE aims to:
- Expand access to in-home and community-based services
- Ensure OhioRISE members and families have the tools they need to direct their interactions with multiple systems, including:
- Child protection
- Developmental disabilities
- Education
- Juvenile justice
- Mental health and addiction
OhioRISE Services
In addition to behavioral health services, OhioRISE services include:
- Care coordination at 3 different levels:
- Tier 1: Limited care coordination is delivered by Aetna for youth needing lower intensity care coordination
- Tier 2: Moderate care coordination (MCC) will be consistent with principles of High-Fidelity Wraparound and will be delivered by a Care Management Entity (CME)-qualified agency for youth with moderate behavioral health needs
- Tier 3: Intensive care coordination (ICC) will be consistent with principles of High-Fidelity Wraparound and will be delivered by a CME-qualified agency for youth with the greatest behavioral health needs
- Intensive home-based treatment (IHBT)
- Psychiatric residential treatment facility (PRTF)
- Mobile response and stabilization service (MRSS)
- Behavioral health respite
- Wraparound supports/flex funds
Collaboration with OhioRISE/CMEs
Providers may submit referrals for member evaluations for OhioRISE to OHMCDOhioRISE@humana.com. Humana’s Care Coordination staff will outreach the member and their family to coordinate a timely CANS assessment to determine OhioRISE eligibility. An individual who is enrolled in the OhioRISE program will keep their managed care enrollment for their physical health benefit. Humana will collaborate with the member’s OhioRISE care team and participate in the OhioRISE Child and Family Team meetings based on the member’s needs and choice.
The Humana Healthy Horizons in Ohio Provider Manual, PDF includes more information about the above services.
Some Humana Healthy Horizons in Ohio members may be enrolled in OhioRISE.
Learn more about OhioRISE
To contact Aetna Better Health of Ohio, the OhioRISE specialized managed care organization, call 833-711-0773 or email OHRise-Network@aetna.com.
