Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-058 - Child Health Management Services #97; Physical and Speech Therapy #89; Developmental Day Treatment Clinic Services #99; Hospital/CAH/End-Stage Renal Disease #128; Physician/Independent Laboratory/CRNA/Radiation Therapy Center #144; Rehabilitative Hospital #91; RSPMI #92; HomeHealth #106; Nurse Practitioner #87

Current through Register Vol. 49, No. 6, June, 2024
Section II Child
			 Health Management Services
217.110
Medical Diagnosis Only
A.
Listing of Medical Diagnoses
The presence of a significant medical diagnosis may be adequate
				to identify a child in need of Child Health Management Services. The following,
				though not a complete list, are examples of diagnoses that may indicate a child
				in need of care. The current clinical medical records relied upon to
				substantiate or support the diagnosis that establishes the need for services
				must accompany all requests for prior authorization or extension of
				benefits.
AIDS
Cerebral Degeneration
Child Maltreatment Syndrome (abuse or neglect) - must provide
				documentation of when and what events occurred and evidence of involvement of
				DHHS in current social situation.
Chronic Renal Failure
CMV
Congenital Heart Disease
Congenital Hypothyroidism
Cystic Fibrosis
Down's Syndrome
Encepholomalacia
Esophageal Atresia
Failure to Thrive - must provide documentation and detailed
				history, medical evaluation, nutritional evaluation and up-to-date growth
				chart.
Gastroschisis
HIV - must provide documentation of medical treatments and
				necessity of daily medical care.
Hydrocephaly with Shunt
Hypopituitarism
Hypoxic Hemmorraghic Encephalopathy
Lead Poisoning - must document lead level and extent of
				injury
Macrocephaly - must have documented head circumference on
				growth chart and medical evaluation with results of MRI, CT, etc.
Metabolic Disorder
Microcephaly - must have documented head circumference on
				growth chart and medical evaluation with results of MRI, CT, etc.
Neuroblastoma
Newborn Intraventricular Hemorrhage - document degree of
				hemorrhage
Periventricular Leukomalacia
Prematurity (less than 37 weeks gestation) - must include
				documentation of neonatal course and any additional significant medical
				problems for a child less than 12 months of age.
Prenatal Drug/Alcohol Exposure - documentation of extent of
				exposure and medical effects of exposure.
Seizure Disorder- does not include febrile seizures.
				Documentation to include medications, type and frequency of seizures.
Sickle Cell Disease - documentation of actual disease, not
				trait. Documentation should include history of treatment for the
				disease.
Spina Bifida
Tracheomalacia
Tuberous Sclerosis and Other Neurodermatoses
Various Syndromes/Severity Determined by Physician
B.
Mechanism for
			 Establishing Need for Care (Medical Only)
A medical diagnosis alone will not adequately document the
				necessity for CHMS. Documentation must include a complete medical evaluation by
				a pediatrician or pediatric specialist to include a history and physical. There
				must be documentation to support the need for ongoing intervention by a medical
				multi-disciplinary diagnosis and treatment team within a CHMS clinic.