10- 144 C.M.R. ch. 272, § VI-VII
Prior authorized services through the C.C.S./C.S.H.N. Program are available for chronic disorders of the blood and circulatory system as follows:
For those children who are referred by their primary care providers for subspecialty evaluation and/or treatment, the C.C.S./C.S.H.N. Program will pre-authorize payment for:
diagnostic evaluation by a pediatric hematologist; and referral to the Maine Hemophilia Treatment Center funded by the Maternal and Child Health Block Grant; clinic visits to the Hemophilia Center and/or office visits with the pediatric hematologist to include treatment for the subspecialty components upon receipt of the report of the evaluation and recommended in the plan of care; medications, blood factor and blood products including FDA approved synthetic hormone stimulant drug therapy and infusion supplies for children who have been prior approved for home infusion; adjunctive drug therapy that requires a written prescription and is specific to the bleeding episode; evaluations for orthopedic complications related to hemophilia when recommended by the primary care physician or treating hematologist; physical therapy evaluations, consultations and rehabilitation of joints for up to thirty (30) days as recommended by a treating subspecialist if related to orthopedic complications of hemophilia; routine preventive dental care up to $150 per year at state rates of reimbursement; Hepatitis B vaccine if not previously immunized; and/or retroactive coverage for emergency out-patient or in-patient care for uncontrolled bleeding including payment of blood factor as needed will be considered after receipt and review of appropriate medical documentation and if the parents notify Coordinated Care Services within one week of the emergency.For those children referred by their primary care providers for subspecialty evaluation/consultation and treatment for bleeding disorders such as Idiopathic Thrombocytopenia, the C.C.S./C.S.H.N. Program will pre-authorize payment for:
diagnostic evaluation with a pediatric hematologist; surgical components of the plan of care and related hospitalization costs upon receipt of the report of the evaluation; office visits with the pediatric hematologist; laboratory tests; medications as prescribed by the pediatric hematologist; and/or blood and blood products.For those children identified by the Newborn Screening Program or referred by their primary care provider for subspecialty consultation and/or treatment the C.C.S./C.S.H.N. Program will pre-authorize payment for:
Evaluation through the Maine Hemophilia Treatment Center or a pediatric hematologist to include laboratory work and blood; retroactive coverage for emergency out-patient or in-patient care for sickle cell and other congenital anemias will be considered after receipt and review of appropriate medical documentation and if the parents notify Coordinated Care Services within one week of the emergency; and/or. medications as prescribed by the pediatric hematologist.10- 144 C.M.R. ch. 272, § VI-VII