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

Effective Date:

Approval Date: 41 Children with Complex Special Health Care Needs. These covered services include outreach, informing, intensive case management, care coordination and community referral.

State-certified Community Health Workers, also known as promotora(s), are utilized in target areas to focus education to under-served populations. The program aims to bridge social, economic and cultural gaps to provide information about effective utilization of CHIP and preventive care to enrolled families. Delivery of Community Health Worker training and services are designed to improve preventive care on the CHIP program.

CHIP Perinatal Program: • Case management services are a covered benefit for the unborn child. • Upon delivery, coverage for the CHIP Perinatal newborn is the same as coverage for CHIP clients.

6.2.21.

Care coordination services (Section 2110(a)(21))

CHIP Perinatal Program: • Care coordination services are a covered benefit for the unborn child. • Upon delivery, coverage for the CHIP Perinatale newborn is the same as coverage for CHIP clients.

6.2.22.

Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Section 2110(a)(22)) Covered, medically necessary habilitation (the process of supplying a child with the means to reach age-appropriate developmental milestones through therapy or treatment) and rehabilitation services include, but are not limited to physical, occupational and speech therapy and developmental assessment.

Reimbursement for school-based services is not covered, except for therapy services ordered by the PCP.

The Health Plan may require authorization and physician prescription.

CHIP Perinatal Program: • Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders are not a covered benefit for the unborn child.