Current through Register Vol. 51, No. 19, September 20, 2024
A. Children
with special health care needs may be eligible for services covered by the CMS
Program.
B. Chronic medical
conditions which may render an applicant medically eligible include, but are
not limited to, the following:
(1) Chronic
asthma;
(2) Chronic renal
disease;
(3) Cystic
fibrosis;
(4) Diabetes and other
endocrine disorders;
(5)
Hemophilia;
(6) Immune
deficiencies;
(7) Juvenile
rheumatoid arthritis;
(8) Leukemia
and other childhood cancers;
(9)
Phenylketonuria and other inborn errors of metabolism; and
(10) Sickle cell anemia and other chronic
anemia.
C. Other medical
and surgical conditions which may render an applicant medically eligible
include, but are not limited to, the following:
(1) Biliary atresia;
(2) Bronchopulmonary dysplasia;
(3) Tracheal esophogeal fistula;
and
(4) Ulcerative
colitis.
D.
Neurodevelopmental conditions which may render an applicant medically eligible
include, but are not limited to, the following:
(1) Brain tumors;
(2) Cerebral palsy and other central nervous
system disorders;
(3) Certain high
risk neonates;
(4) Closed head
injury with residual defects;
(5)
Down's syndrome and other genetic and chromosomal anomalies;
(6) Hydrocephalus;
(7) Medical aspects of learning disabilities
and attention deficit disorders;
(8) Medical aspects of intellectual
disability and developmental delay;
(9) Muscular atrophies and
dystrophies;
(10) Spina bifida,
myelomeningocele, and the spinal cord dysfunctions;
(11) Other neurologic damage;
(12) Peripheral neuromuscular disease;
and
(13) Seizure
disorder.
E. Orthopedic
conditions which may render an applicant medically eligible include, but are
not limited to, the following:
(1) Chronic
conditions resulting from trauma;
(2) Chronic infections of bones and
joints;
(3) Club foot and other
foot deformities;
(4) Congenital
developmental hip conditions such as congenital hip dislocation;
(5) Limb deficiencies and length
discrepancies;
(6) Skeletal
dysplasias and other forms of dwarfism; and
(7) Spinal column defects and
deformities.
F. Cardiac
conditions which may render an applicant medically eligible include, but are
not limited to, the following:
(1)
Arrhythmias;
(2) Congenital heart
defects;
(3) Hypertension;
and
(4) Rheumatic heart
disease.
G. Craniofacial
and dental conditions which may render an applicant medically eligible include,
but are not limited to, the following:
(1)
Cleft lip and palate, orofacial defects;
(2) Handicapping malocclusions; and
(3) Medically necessary dental care related
to eligible medical conditions.
H. Vision, hearing and speech-language
conditions, which may render an applicant medically eligible include, but are
not limited to, the following:
(1)
Amblyopia;
(2) Cataract;
(3) Cholesteatoma;
(4) Chronic otitis media;
(5) Conductive and sensory-neural hearing
loss;
(6) Otosclerosis;
(7) Speech-language disorders;
(8) Strabismus; and
(9) Velopharyngeal incompetence.
I. The following are excluded from
CMS Program medically eligible services:
(1)
Well child care;
(2) Mental
health;
(3) Emergency care;
and
(4) Urgent care.
J. Care excluded from CMS Program
medically eligible conditions unless the services are medically necessary due
to the underlying chronic condition includes:
(1) Dermatology;
(2) Gynecology; and
(3) Dental services.
