Sec. 10.11.03.03. Covered Services

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.