10- 144 C.M.R. ch. 272, § VI-X
Early intervention diagnostic, therapeutic and referral services may be available through the C.C.S./C.S.H.N. Program for pediatric developmental conditions to include gross and fine motor delays and speech language delays for children from birth up to age eligibility for school entry if the child is referred or in a C.C.S./C.S.H.N. prior authorized therapy program by (March 15) of the year the child is age eligible for school.
Coordinated Care Services For Children With Special Health Needs supports community-based Developmental Evaluation Clinics which provide a comprehensive, inter/multi-disciplinary, medically-based, diagnostic assessment to those children under the age of five with suspected developmental problems, who are referred/verified by their primary care provider. The clinics offer, without regard to income, comprehensive evaluations to:
establish developmental baselines; attempt to establish the cause of the identified problems through appropriate tests; and develop a comprehensive individualized plan of care addressing the child's health issues and developmental problems which recommends specific interventions where indicated.Upon referral, application and determination of income eligibility the C.C.S./C.S.H.N. Program may pre-authorize additional diagnostic studies, laboratory tests and or genetic studies with a Division of Maternal and Child Health grant-funded genetics program only when recommended by a Developmental Evaluation Clinic team and outlined in the evaluation report;
For income eligible children who are ineligible for Medicaid, may lose Medicaid within three (3) months or are not age or otherwise eligible for services through P.L. 101.476, Individuals with Disabilities Education Act and who are referred by their primary care provider, pediatric specialist or subspecialist and/or a Developmental Evaluation Clinic for direct therapeutic services, the C.C.S./C.S.H.N. Program may pre-authorize payment as follows:
For those children ages 0 -24 months who have identified oral motor difficulties, such as but not limited to, problems with swallowing, chewing, drooling, excessive drooling, coughing at meals, and /or abnormal oral reflexes. which effect feeding and who require occupational and/or speech therapy intervention and who are referred by their treating subspecialist, a Developmental Evaluation Clinic or another C.C.S./C.S.H.N. supported clinic, the C.C.S./C.S.H.N. Program will prior authorize payment for:
diagnostic consultation with an approved feeding team which shall include a speech language pathologist, occupational therapist and registered dietitian. diagnostic evaluation with a licensed speech language pathologist and/or occupational therapist for up to three (3) thirty-minute units. The evaluation must include a comprehensive analysis of the child's oral motor skills, clearly stated levels of functioning in each area and recommendations for intervention; two (2) units or one hour session with a licensed speech language/occupational therapist for the purpose of development of a therapy plan of care which will include involvement of the parents and a registered dietitian if needed in the intervention recommended with specificity as to duration and number of anticipated therapy sessions required; individualized therapy to include consultation with the parents, for a maximum of sixty (60) units or thirty hours with a speech language or occupational therapist over a six month period of time with progress reports required at the end of the six month therapy period. Requests for continuation of therapy will be reviewed on a per child basis and must be at the recommendation of both the treating subspecialist and therapist. medical nutrition therapy to include parent counseling for a maximum of two (2) units per session per week with a registered dietitian for up to sixty days; and additional diagnostic studies and laboratory tests only when recommended by a Developmental Evaluation Clinic team and outlined in the evaluation report;For income eligible children with a gross or fine motor delay of at least ten (10) but not more than (18) months or a speech language delay of at least six (6) months but not more than twelve (12) who are not eligible for services through P.L. 101.476, Individuals with Disabilities Education Act and who are ineligible for Medicaid or may lose Medicaid within three (3) months and are referred or in a C.C.S./C.S.H.N. prior authorized therapy program six (6) months prior to the time they enter elementary school, the C.C.S./C.S.H.N. Program may pre-authorize payment for diagnostic and direct therapeutic services, as follows:
diagnostic evaluation with a licensed occupational/physical therapist and/or speech language pathologist for up to three (3) thirty-minute units. The evaluation must include a comprehensive analysis of the child's fine and gross motor skills, oral motor function where indicated and/or speech language skills with clearly stated levels of functioning in each area and definitive recommendations for intervention; two (2) units or one hour session with a licensed occupational, and/or physical therapist and/or speech language pathologist for the purpose of development of a measurable therapy treatment plan. Care plans shall be developed based on information obtained in the diagnostic evaluation and shall include the following: long and short term goals and objectives with measurable criteria; treatment methods and benchmarks for evaluating outcomes; the therapist's plan for including family participation in meeting the goals and objectives and in reinforcing the therapeutic activities; frequency and length of sessions (in thirty-minute units), time period covered, and estimated length of treatment; individualized occupation, physical and/or speech language therapy at a maximum of two (2) units/sessions, three (3) sessions per week for up to six (6) months with progress reports and updated treatment plans required at the end of each six month period and before another prior authorization is issued; and short term therapy, i.e., six month or less, as an adjunct to comprehensive subspecialty care for underlying medically treatable physical problems if prescribed by the prior authorized provider.NON COVERED DEVELOPMENTAL SERVICES: speech language therapy for children with a congenital hearing loss. These children will be referred to the Department of Education, Office of Deafness.
10- 144 C.M.R. ch. 272, § VI-X