Regulation .03 Covered Services.
Regulation .03 Covered Services.LinkCopy Citation
A.
The CMS Program shall authorize covered services when a CMP has been approved.
B.
The CMP shall:
(1)
Include:
(a)
All diagnoses or suspected diagnoses;
(b)
Service requested or provided;
(c)
Specific reason for the service request;
(d)
Evaluation or treatment findings;
(e)
Follow-up plans related to the service provided by the CMS Program;
(f)
Source of primary health care; and
(2)
Be reviewed and approved by the CMS Program.
C.
The CMS Program may request further information from the provider in order to:
(1)
Support the information required in §B(1) of this regulation;
(2)
Assure that all services are coordinated with other services the child is receiving through the CMS Program or other programs; and
(3)
Assure that the needs of the family are addressed in relation to meeting the medical and developmental needs of the child.
D.
CMS Program eligible services shall include:
(1)
Specialty clinics;
(2)
Private office care including, but not limited to, the following:
(a)
Allergy/Immunology;
(b)
Audiology and hearing;
(c)
Cardiology;
(d)
Craniofacial;
(e)
Cystic fibrosis;
(f)
Developmental pediatrics;
(g)
Endocrine;
(h)
Gastroenterology;
(i)
Genetics;
(j)
Hematology;
(k)
Infectious disease;
(l)
Nephrology;
(m)
Neurology;
(n)
Neurosurgery;
(o)
Oncology;
(p)
Ophthalmology, optometry, and vision;
(q)
Orthopedics;
(r)
Otolaryngology;
(s)
Physical medicine;
(t)
Plastic surgery;
(u)
Pulmonology;
(v)
Rheumatology;
(w)
Speech-language pathology;
(x)
Surgery; and
(y)
Urology.
(3)
Primary physician care arranged at the discretion of the CMS Program to assure access for needed specialty diagnostic evaluation, treatment, and care coordination services;
(4)
Inpatient hospital care services, which are provided by Medical Assistance affiliated hospitals; and
(5)
Professional evaluation and treatment services, which may include, but are not limited to, the following:
(a)
Audiology;
(b)
Family training and counseling regarding medical and rehabilitation needs;
(c)
Genetic counseling;
(d)
Nursing;
(e)
Nutrition;
(f)
Occupational therapy;
(g)
Physical therapy; or
(h)
Speech-language pathology.
E.
Specialized activities to facilitate a special treatment program may include, but are not limited to, the following:
(1)
Equipment to provide:
(a)
Life support;
(b)
Mobility;
(c)
Stimulation; and
(d)
Aid in activities of daily living;
(2)
Orthoses to correct or prevent orthopedic disabilities, including prescription shoes and their modifications;
(3)
Prostheses to replace a missing part or to enhance the applicant's functional performance;
(4)
Formula and medication to correct metabolic and physiologic errors;
(5)
Supplies of durable and disposable items to facilitate management of specific disorders;
(6)
Approved therapies involving specific treatment as authorized by appropriate CMS Program professional staff to cure functional deficiencies;
(7)
Life sustaining medications;
(8)
Dental services provided for children with disabling conditions; and
(9)
Hearing aids and augmentative devices to improve communication.