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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 83 6.2.2.  Outpatient services (Section 2110(a)(2)) 6.2.3.  Physician services (Section 2110(a)(3)) 6.2.4.  Surgical services (Section 2110(a)(4)) 6.2.5.  Clinic services (including health center services) and other ambulatory health care services. (Section 2110(a)(5)) 6.2.6.  Prescription drugs (Section 2110(a)(6)) 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)) 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) PIC services will be limited to CMSN Title XXI enrolled children with life-threatening conditions and will include counseling services. 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))

PIC services will be limited to CMSN Title XXI enrolled children with life-threatening conditions and will include respite services. 6.2.15.  Nursing care services (See instructions) (Section 2110(a)(15))

PIC services will be limited to CMSN Title XXI enrolled children with life-threatening conditions and will include pain and symptom control,