Current through Register No. 40, October 3, 2024
(a) Medicaid covered services shall be
provided to children as part of the residential component of a residential
treatment program or foster care program and shall not be billed to the
Medicaid to schools program pursuant to He-M 1301.
(b) Covered services shall be approved by the
prescribing practitioner to be medically necessary, using the following
criteria:
(1) The services are designed to
provide maximum reduction of physical, intellectual, or behavioral disability
and restore a child to his or her best possible functional level; and
(2) There is no other equally effective
course of treatment available on a fee-for-service basis that is more
conservative, less restrictive, or substantially less costly than the per diem
rate for residential treatment program or foster care program
services.
(c) Covered
services shall:
(1) Be provided in accordance
with a child's treatment plan; and
(2) Be designed to meet the health and
rehabilitative needs of a child to address his or her physical, intellectual,
or behavioral disability.
(d) Covered services shall include:
(1) Nursing services;
(2) Occupational therapy, including
evaluations, treatments or consultations necessary to implement a program of
activities to develop or maintain skills necessary to achieve adequate and
appropriate physical and mental functioning of a child;
(3) Physical therapy, when provided by or
under the supervision of a physical therapist, and for which there shall be a
physician's written authorization for individual or group treatment, supplies,
and equipment related to physical therapy;
(4) Psychiatric services when necessary for
the evaluation, diagnosis, and treatment of psychiatric problems;
(5) Psychological services when necessary for
the evaluation, diagnosis, and treatment of emotional or behavioral problems or
disturbances;
(6) Speech, language
and hearing services when necessary for the evaluation, diagnosis, and
treatment of speech, language, and hearing disorders;
(7) Rehabilitative services, which shall be
included in the treatment plan and based on a physician's written referral or a
recommendation from a prescribing practitioner;
(8) Behavioral health, other than psychiatric
and psychological services referenced in (4) and (5) above; and
(9) Any other remedial services as are
necessary for the maximum reduction of a child's physical, intellectual, or
behavioral disabilities, excluding classroom instruction and academic
tutoring.
(e) Nursing
services referenced in (d) (1) above shall be performed by an RN, LPN or ARNP,
and shall include:
(1) Any evaluations,
treatments, staff training, or consultations that are necessary for the child
to be safely cared for;
(2)
Administration of medication;
(3)
Observation of children with chronic or acute illnesses in order to assure that
medical needs are being appropriately identified, addressed and monitored;
and
(4) Other services allowed
under their individual identified scope of practice for nursing
services.
(f) Physical
therapy services referenced in (d) (3) above shall include:
(1) Evaluations;
(2) Treatment; and
(3) Consultation that might prevent, restore
or alleviate a loss of or impairment of a physical function.
(g) Rehabilitative services
referenced in (d) (7) above shall include:
(1) Assistance with communication;
(2) Behavior management;
(3) Nutrition counseling;
(4) Medication management and
training;
(5) Hygiene and personal
care training;
(6) Coordination of
medical care; and
(7) Development
and implementation of individual treatment plans.
(h) Behavioral health services referenced in
(d) (8) above shall include, at a minimum:
(1) Behavior management;
(2) Individual, group, and/or family
counseling;
(3) Substance use
disorder counseling; and
(4) Crisis
intervention and stabilization.
#9028, eff
11-17-07
