The Commonwealth of Massachusetts Executive Office of Health and Human Services www.mass.gov/masshealth 01/21/2010 EPS-3026-D MID: Re: A note to remind you of MassHealth benefits for checkups It’s important for children, teens, and young adults to see their primary-care doctor or nurse for regular checkups. Well-care checkups are a good way to help you stay healthy. Small problems that are found early can be taken care of before they become big problems. If you are under 21 years old, MassHealth and its managed care organization plans (MCOs) pay for well -care checkups and treatment services. Use this chart to help you know when it’s time for a checkup. 1 to 2 weeks old 1 month old 2 months old 4 months old 6 months old 9 months old 12 months old 15 months old 18 months old Once a year if you are between 2 and 20 years old EPS-3026-D (Rev. 01/10) Why are checkups important? What happens during a checkup? Your checkup is a good time to ask questions. You can get information and help about safety, healthy food, preventing infections, and growth and development. You can also understand what to expect at certain ages. You can get help for behavioral health problems and any other health concerns you may have. During a checkup, your primary-care doctor or nurse will do a full physical examination. They will also do the following. • Check your height, weight, vision, hearing, and dental health • Screen you for healthy nutrition, growth and development • Check for physical and behavioral health (mental health and substance abuse) problems • Do any other lab tests you need based on your age or health condition • Talk with you about any illnesses and operations you had and any drugs you take • Make sure your immunizations (shots) are up to date What about flu vaccines? It is important for children over six months old to get a seasonal flu vaccine every year. Some years an extra flu vaccine, like H1N1, is needed too. MassHealth and the MCOs cover the vaccines at your doctor’s office, and other locations too. You can call MassHealth or your MCO Customer Service Center for help finding such a place. You can find your health plan’s Customer Service Center phone number on your health-plan card. Time to see a dentist? Your doctor or nurse will check the health of your mouth and teeth. Some doctors will also apply fluoride. They will recommend that you see a dentist every six months. Babies should start seeing the dentist when their first tooth comes in, or by the time they turn 12 months old. MassHealth pays for dental screenings, cleanings, fluoride treatment, and other dental services. These will be provided by a MassHealth dentist. You do not need a referral to see a dentist. Checking for Behavioral Health Needs? As part of the checkup, your doctor or nurse will offer to use a screening tool. This tool helps to check your behavioral health. This is a short list of questions that a parent, teen, or young adult fills out. You and your doctor or nurse can talk about your answers. Discussing will help you and your doctor or nurse decide if you need more follow-up care. Follow-up care can be by a medical professional or a behavioral health provider. Your doctor or nurse can help you find a provider who is right for you. You don’t need a referral to get behavioral health services. If you go to see a behavioral health provider, they will use an assessment tool. It is called the Child and Adolescent Needs and Strengths (CANS). It helps to collect and record your strengths and needs. The CANS also helps you and your provider plan your treatment and check your progress. As you continue to see your behavioral health provider they will update the information in CANS. This update is done at least every three months. Ask your behavioral health provider to tell you more about CANS. MassHealth and its MCOs pay for many behavioral health services. These services include the following. • Outpatient therapy • Intensive care coordination • Family support and training (“family partners”) • In-home therapy • Mobile crisis intervention • Therapeutic mentoring • In-home behavioral services Page: 2 What if I need treatment after a checkup? You and your doctor or nurse should talk about any treatment that you need after the checkup. Some services may need a referral. Talk to your primary-care doctor or nurse, dentist, behavioral health provider, or other specialist. You may also call your MassHealth or MCO Customer Service Center for help in getting these services. You can find your health plan’s Customer Service Center phone number on your health-plan card. A program called Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services covers children, teens, and young adults under 21 years old who are enrolled in MassHealth Standard or CommonHealth. MassHealth and its managed care organization plans (MCOs) pay for all medically necessary services that are needed to treat a medical or behavioral health problem. They will pay for them even if the services are not already provided by MassHealth or your MCO. They are covered if they can be covered under federal Medicaid law. Most of the time, services that you need will be covered under your plan. If the service is not already covered, the clinician or provider who is giving you the service can ask MassHealth or your MCO for prior authorization (PA). The plan will decide if there is a medical need for the service. You and your health care provider can call MassHealth or contact your MCO’s Customer Service Center for information like • what providers may be available to give you these services; or • how to use out-of-network providers. A program called preventive pediatric health-care screening and diagnosis (PPHSD) services covers children, teens, and young adults under 21 years old, who are enrolled in MassHealth Basic, Essential, Prenatal, and Family Assistance. MassHealth and its managed care organization plans (MCOs) pay for all covered services that are needed to treat a medical or behavioral health problem. This means that when a primary-care doctor or nurse (or any other clinician) identifies a health problem, MassHealth or your MCO will pay for any medically necessary treatment that is included in your plan. You and your health care provider can call MassHealth or your MCO’s Customer Service Center to find out what providers may be available to give you these services. Call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people with partial or total hearing loss) or call your MCO Customer Service Center (the number is on the back of your health plan card) to • find out what services you or your child can receive; • get help finding or making an appointment with a health-care provider; • get help with your questions about your coverage for services; • get information about transportation services to get to a medical, behavioral health or dental appointment; • learn more about other MassHealth-covered services, such as family-planning services; • get help if you have any questions or problems with services from MassHealth providers; • find out about other services, such as Supplemental Nutritional Assistance Program (SNAP) and Early Intervention; and • change doctors or health plans. For information about the Women, Infants, and Children (WIC) Nutrition Program, which provides nutrition and health education, healthy food, and other services free of charge to pregnant and breastfeeding women and to infants and children under age five, call 1-800-WIC-1007 (TDD/TTY: 617-624-5992 for people with partial or total hearing loss). Page: 3 This page intentionally left blank Page: 4