Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VI - CONDITIONS AND COMPONENTS OF CARE › Section 144-272-VI-VII - HEMATOPOIETIC SYSTEM

Current through 2024-29, July 17, 2024
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:
A.
Hemophilia
				  and Other Factor Deficiencies
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.
B.
Other Coagulophathies (Bleeding Disorders
)
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.
C.
Sickle Cell Anemia and Other Congenital Anemias
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.