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-II - MUSCULOSKELETAL SYSTEM

Current through 2024-29, July 17, 2024
Prior authorized services through the C.C.S./C.S.H.N.
					 Program are available for congenital or acquired diseases or conditions of the
					 musculoskeletal system that requires corrective subspecialty medical, or
					 surgical treatment as follows:
A.
Cleft Lip and Palate:
In the event of a pre-natal diagnosis, the family will be
					 referred to the Coordinator of the in-state Cleft Lip and Palate Clinics
					 administered by Coordinated Care Services for Children with Special Health
					 Needs Program. Upon the child's arrival to a hospital for definitive care, the
					 Coordinator of the Cleft Lip and Palate Clinic will provide a hospital or
					 home-based visit with the family. The purpose of this visit is to provide
					 information, facilitate application to the C.C.S./C.S.H.N. Program and referral
					 to the Cleft Palate clinics for evaluation and development of a comprehensive
					 plan of care. Cleft Lip and Palate Clinic, and
planning services are available to all children with cleft
					 lip and palate and certain other craniofacial anomalies who are enrolled in the
					 C.C.S./C.S.H.N. Program, without regard to income. There are two types of
					 clinics:
1. Infant Cleft Palate Clinic
				  For Children Ages Birth Up To Two Years Of Age: 
				  
												provides information to the parents about their
						child's condition;
												provides genetic consultation/counseling;
												 clinic team consists of: a pediatrician, plastic
						surgeon, pediatric dentist, speech/language pathologist, medical social work
						consultatant, geneticist, and a clinic coordinator.
2.
				  Cleft Palate Clinic For Children Ages Two Years Up To Eighteen Years Of Age:
) provides a comprehensive evaluation of each child;
) clinic team develops a comprehensive plan of care that
					 stipulates what needs to be done; outlines the time frames and recommended
					 sequence of services;
) clinic team consists of: a pediatrician, plastic surgeon,
					 prosthodontist, oral surgeon, otolaryngologist, pediatric dentist,
					 orthodontist, geneticist, audiologist, speech/language pathologist, medical
					 social work consultant, and a clinic coordinator.
For income eligible children, the C.C.S./C.S.H.N. Program
					 will pre-authorize payment for the subspecialty medical and dental components
					 of care recommended by the Cleft Palate Clinic team or specific subspecialty
					 treatment by the prior authorized subspecialist as follows:
surgery and related hospitalization
						costs;
												 office visits with the appropriate subspecialist to
						include ENT care;
												 laboratory tests, x-rays and other imaging
						studies,
												 prostheses and replacements;
												 consultation with an approved feeding team which
						shall include a speech language pathologist, occupational therapist and
						registered dietitian;
												 orthodontics to include bracing and
						appliances;
												 routine and restorative dental care;
												genetic consultation and appropriate genetic studies
						through a MCH grant funded and approved in-state genetics program and specified
						in the recommendations of the Cleft Palate Clinic team;
												audiological evaluations with a Maine licensed
						audiologist if recommended; and/or
												 speech/language therapy evaluation and treatment for
						pre-schoolers with a Maine licensed speech/language pathologist as defined for
						length and frequency in Chapter VI, Secion X, p. 41-44. Therapy is also
						available on a trial basis as part of a planned evaluation in consultation with
						the pre-authorized plastic surgeon to determine a child's need for further
						surgery.