Page 81

State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 80

Healthy Kids: Covers all prescriptions in the same manner in which the Florida Medicaid program provides. Participant is limited to the generic drug unless a generic is not available or the prescriber indicates that the brand name is medically necessary. 6.2.7.  Over-the-counter medications (Section 2110(a)(7)) 6.2.8.  Laboratory and radiological services (Section 2110(a)(8)) 6.2.9.  Prenatal care and prepregnancy family services and supplies (Section 2110(a)(9)) 6.2.10.  Inpatient mental health services, other than services described in 6.2.18, but including services furnished in a state-operated mental hospital and including residential or other 24-hour therapeutically planned structural services (Section 2110(a)(10)) Healthy Kids inpatient mental health benefits include 30 inpatient/residential days per contract year. If residential services are used then at least 10 days must be reserved for inpatient services. Effective October 1, 2009, the days limits have been removed from this benefit. 6.2.11.  Outpatient mental health services, other than services described in 6.2.19, but including services furnished in a state-operated mental hospital and including community-based services (Section 2110(a)(11) Healthy Kids: Outpatient behavioral health benefits are limited to 40 outpatient visits per contract year. Effective October 1, 2009, the visit limits have been removed from this benefit. 6.2.12.  Durable medical equipment and other medically related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices) (Section 2110(a)(12)) 6.2.13.  Disposable medical supplies (Section 2110(a)(13)) 6.2.14.  Home and community-based health care services (See instructions) (Section 2110(a)(14))

Healthy Kids: Home health services are limited to skilled nursing services only. The benefit is intended to provide services on a limited, part-time intermittent basis and excludes meals, housekeeping and personal comfort items.