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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 81 6.2.15.  Nursing care services (See instructions) (Section 2110(a)(15))

Healthy Kids: Nursing services in Healthy Kids are limited to skilled nursing only. 6.2.16.  Abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest (Section 2110(a)(16) 6.2.17.  Dental services (Section 2110(a)(17))

Children enrolled in MediKids and the CMSN receive Medicaid dental benefits from Medicaid-enrolled providers. Healthy Kids: Healthy Kids enrollees also receive the Medicaid dental benefit package. See Section 6.2.-D Effective July 1, 2010, Healthy Kids dental benefits are provided statewide by two (2) commercially licensed dental insurers. The annual dental benefit limit was eliminated to comply with CHIPRA legislation. If a child needs oral surgery due to an accident or injury to the mouth or jaw, this coverage would still be provided under the child’s medical services contractor and not the dental contractor. 6.2.18.  Inpatient substance abuse treatment services and residential substance abuse treatment services (Section 2110(a)(18))

Healthy Kids: Inpatient behavioral health services are limited to not more than 7 inpatient days per contract year for medical detoxification only and 30 residential days. Effective October 1, 2009, the day limits on inpatient and residential services have been removed. 6.2.19.  Outpatient substance abuse treatment services (Section 2110(a)(19))

Healthy Kids: Outpatient visits are limited to 40 outpatient days per contract year. Effective October 1, 2009, the visit limit on outpatient services has been removed. 6.2.20.  Case management services (Section 2110(a)(20)) 6.2.21.  Care coordination services (Section 2110(a)(21))

Care coordination services is limited to CMSN Title XXI enrolled