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Title 5: Centrally Administered Programs Page 72 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Approval of hawk-i Coverage Revised July 3, 2009 Required Services Required Services Legal reference: 441 IAC 86.14(1) The participating health plan shall cover the following medically necessary services: ♦ Inpatient hospital services (including medical, surgical, intensive care unit, mental health, and substance abuse services). ♦ Physician services (including surgical and medical, and including office visits, newborn care, well-baby and well-child care, immunizations, urgent care, specialist care, allergy testing and treatment, mental health visits, and substance abuse visits). ♦ Outpatient hospital services (including emergency room, surgery, lab, and x-ray services and other services). ♦ Ambulance services. ♦ Physical therapy. ♦ Nursing care services (including skilled nursing facility services). ♦ Speech therapy. ♦ Durable medical equipment. ♦ Home health care. ♦ Hospice services. ♦ Prescription drugs. ♦ Dental services (including restorative and preventative services). ♦ Hearing services. ♦ Vision services (including corrective lenses). ♦ Abortion. Payment for abortion shall be made only when either: • The pregnancy was the result of an act of rape or incest; or • The physician certifies that the pregnant enrollee suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would place the enrollee in danger of death unless an abortion is performed.