Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS
Chapter VI - CONDITIONS AND COMPONENTS OF CARE
Section 144-272-VI-V - GASTROINTESTINAL SYSTEM

A. Congenital Anomalies

For those children who are referred by their primary care providers for subspecialty evaluation and/or treatment for such conditions as but not limited to: atresias of G.I.-tract, diaphragmatic hernia, Hirschsprung's disease, malrotation, omphalocele and tracheoesophageal fistula, the C.C.S./C.S.H.N. Program will pre-authorize payment for:

a diagnostic evaluation/consultation by a pediatric gastroenterologist and/or pediatric surgeon. This evaluation may include diagnostic studies and related hospitalization costs. surgical components of the plan of care and related hospitalization costs upon receipt of the report of the evaluation; office visits with the gastroenterologist; consultation with an approved feeding team that includes a speech language pathologist, occupational therapist and nutritionist if prescribed by the gastroenterologist; laboratory tests and imaging studies; and/or medications as prescribed by the gastroenterologist;

B. Other Gastrointestinal Problems

For those children who are referred by their primary care providers for subspecialty evaluation and/or treatment for such conditions as but not limited to gastroesphogeal reflux, motility disorders, regional enteritis and/or ulcerative colitis, the C.C.S./C.S.H.N. Program will pre-authorize payment for:

a diagnostic evaluation/consultation by a pediatric gastroenterologist; surgical components of the plan of care and related hospitalization upon receipt of report of the evaluation; office visits with the gastroenterologist; laboratory tests and medications as prescribed by the gastroenterologist; and/or