Except as provided in par. (be), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following federally mandated benefits: 1.
(1)#
Physicians’ services, excluding services provided under par. (b) 6. f.
(2)#
Early and periodic screening and diagnosis, including case management services, of persons under 21 years of age and all medical treatment and dentists’ services found necessary by this screening and diagnosis.
(3)#
Rural health clinic services.
(4)#
The following medical services if prescribed or ordered by a provider acting within the scope of the provider’s practice under statutes, rules, or regulations that govern the provider’s practice: a. Inpatient hospital services other than services in an institution for mental diseases, including psychiatric and alcohol or other drug abuse treatment services. b. Services specified in this paragraph, provided by any hospital on an outpatient basis. c. Skilled nursing home services other than in an institution for mental diseases, except as limited under s. 49.45 (6c) and (30m) (b) and (c). d. Home health services, subject to the limitation under s. 49.45 (8), or, if a home health agency is unavailable, nursing services. e. Laboratory and X-ray services. f. Services and supplies for family planning, as defined in s. 253.07 (1) (a).
(4)(a)#
Inpatient hospital services other than services in an institution for mental diseases, including psychiatric and alcohol or other drug abuse treatment services.
(4)(b)#
Services specified in this paragraph, provided by any hospital on an outpatient basis.
(4)(c)#
(4m)#
Nurse-midwifery services.
(6)#
Premiums, deductibles and coinsurance and other cost-sharing obligations for items and services otherwise paid under this subsection that are required for enrollment in a group health plan, as specified in sub. (1) (m), except that, if enrollment in the group health plan requires enrollment of family members who are not eligible under this subsection, the department shall pay, if it is cost-effective, for an ineligible family member only the premium that is required for enrollment in the group health plan.