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