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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 6-6 preventive and therapeutic purposes will be covered. Vitamin coverage need not be mandated except when necessary to treat a diagnosed illness or condition.

6.2.7.

Over-the-counter medications (Section 2110(a)(7))

Scope of Coverage: Non-prescription medications authorized by a professional licensed to write prescriptions.

Level of Coverage: All medications used for preventive and therapeutic purposes authorized by a professional licensed to write prescriptions will be covered.

6.2.8.

Laboratory and radiological services (Section 2110(a)(8))

● Diagnostic and Laboratory Tests

Scope of Coverage: Prescribed ambulatory clinical laboratory tests and diagnostic x-rays.

Level of Coverage: No limitations.

6.2.9.

Prenatal care and pre-pregnancy family services and supplies (Section 2110(a)(9))

● Family Planning or Contraceptive Medications or Devices

Scope of Coverage: Prescription medications must be authorized by a professional licensed to write prescriptions.

Level of Coverage: Prescriptions must be medically necessary. May be limited to generic medications where medically acceptable.

● Prenatal Care

See Section 6.2.28.

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))

Scope of coverage: Services provided in a facility operated by the Office of Mental Health under Section 7.17 of the Mental Hygiene Law, or a facility issued an operating certificate pursuant to Article 23 or Article 31 of the Mental Hygiene Law or a general hospital as defined in Article 28 of the Public Health Law.

Level of coverage: No limitations.