Regulation .04 Covered Services.
Regulation .04 Covered Services.LinkCopy Citation
A.
The Program covers the following inpatient services at special pediatric hospitals:
(1)
A hospital admission determined to be medically necessary for a participant who is stable enough for transfer to a post-acute setting and requires medical or rehabilitative services that:
(a)
Cannot be provided at a lower level of care; and
(b)
Meets the medical eligibility criteria under Regulation .06 of this chapter;
(2)
Administrative days for the length of time certified by the Department or its designee;
(3)
Inpatient admissions for intensive occupational therapy, physical therapy, or speech therapy on a regimen which is less than 3 hours per day, 5 days per week, when these services are provided in a unit that is accredited by the Commission on Accreditation of Rehabilitation Facilities to provide rehabilitation services; and
(4)
Ancillary services.
B.
The Program covers the following outpatient hospital services:
(1)
Medically necessary services for the provision of diagnostic, curative, palliative, or rehabilitative treatment; and
(2)
For a participant younger than 21 years old, physical therapy, occupational therapy, speech therapy, and audiology services if:
(a)
The therapy provider develops a written plan of treatment in collaboration with the participant’s primary care physician and the participant or the parent or guardian of the participant;
(b)
The service is provided according to the plan of treatment; and
(c)
The services provider sends an update of the plan of treatment to the participant’s primary care physician every 90 days.