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

Effective Date: August 24, 2001

Approval Date: 33

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

Outpatient treatment for substance abuse services are covered in certified facilities designed specifically for chemically dependent adolescents. Programs designed for substance abusing pregnant women are covered. Services are not included in the PCCM program however, referrals from a physician or court are required. Services are prior authorized. Services are limited to 60 hours in a 12-month period.

6.2.20. X Case management services (Section 2110(a)(20))

Case management services are provided to all SCHIP children through the primary care case management program. Each program enrollee select or is assigned a primary care case management physician to provide the management and treatment of medical conditions and provide for referral for specialty care services. The primary care case manager can be either a physician (Family Practice, Internal Medicine, Pediatrics, OB-GYN, General Practice) or rural health clinic, federally qualified health center, or IHS facility. Services excluded from case management are emergency services, family planning, dental, podiatry, optometry, chiropractic, immunization, transportation and mental health services for chronically mentally ill clients.

Targeted case management services are available to severely and persistently mentally ill individuals at least 18 years of age when obtained from a certified case manager. The case managers provide face to face services including client identification and follow up, coordination of needs assessments, development of a case management plan, service mobilization, linkage and case monitoring. Services must include at least four units of service per month and non face to face services are limited on a monthly basis.

6.2.21. ∼ Care coordination services (Section 2110(a)(21))

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

Physical therapy, occupational therapy, and services for individuals with speech, hearing and language disorders are covered when provided under forms of coverage in 6.2.1, 6.2.2, 6.2.4, 6.2.5, and 6.2.14. The services are also available from individual providers