Tenn. Comp. R. & Regs. 1200-11-02-.04

Current through September 10, 2024

Section 1200-11-02-.04 - COVERED SERVICES

Services will be provided according to the availability of funds. However, when budget constraints are indicated, the Department may place a cap on enrollment in the program and/or a cap on expenditures per participant.

Covered services may include the following.

(1) appropriate replacement therapy needed for the prevention and control of bleeding.

(2) out-patient services related to bleeding disorders as follows:

(a) physician's services - primary and specialty;

(b) emergency room services;

(c) x-ray services;

(d) laboratory services;

(e) pharmaceuticals - included on the program's formulary;

(f) occupational and physical therapy services;

(g) orthopedic - appliances and equipment; and

(h) other bleed-related services as prescribed.

(3) in-patient hospitalization for bleeding episodes and complications.

(4) dental services.

(5) home health care including nursing services and auxiliary supplies.

(6) case management services.

(7) medical insurance premiums for eligible program participants including TennCare premiums, Medicare buy-in for Part B coverage, and premiums for conversion coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986.

(8) diagnostic evaluations needed by program non-participants to determine their eligibility for the program.

(9) support of the Comprehensive Hemophilia Clinics.

Tenn. Comp. R. & Regs. 1200-11-02-.04

Original rule filed April 3, 1974, effective May 3, 1974. Amendment filed July 27, 1977, effective August 26, 1977. Repeal and new rule filed May 15, 2000; effective September 28, 2000.

Authority: T.C.A. §§ 4-5-202, 53-5604, 68-41-102 and 68-41-104.