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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 84 nursing, and personal care services.

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))

6.2.18.  Inpatient substance abuse treatment services and residential substance abuse treatment services (Section 2110(a)(18))

6.2.19.  Outpatient substance abuse treatment services (Section 2110(a)(19))

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 children. 6.2.22.  Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Section 2110(a)(22))

6.2.23.  Hospice care (Section 2110(a)(23))

6.2.24.  Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services. (See instructions) (Section 2110(a)(24))

PIC services will be limited to CMSN Title XXI enrolled children with life-threatening conditions and will include expressive therapies.

Expressive therapies include art, music and play therapies. All expressive therapies must be provided by a registered or board certified provider who has documented experience with children. Services provided by counselors who employ the limited use of music, art, dance or play in their counseling are not included in this service category.

These therapies are tied to a specific therapeutic goal in the patient’s plan of care. The services are not for recreation but are related to care and treatment related to the individual’s health status. The services will