Covered BENEFITS
CSHCS covers services that are medically necessary, related to the beneficiary’s qualifying diagnosis(es), and ordered by the beneficiary’s CSHCS authorized specialist(s) or subspecialist(s). Services are covered and reimbursed according to Medicaid policy unless otherwise stated in this chapter.
The primary CSHCS benefits may include:
* Ambulance
* Care Coordination*
* Case Management*
* Dental (Specialty and General)
* Dietary Formulas (limited)
* Durable Medical Equipment (DME)
* Emergency Department (ED)
* Hearing and Hearing Aids
* Home Health (intermittent visits)
* Hospice*
* Hospital at approved sites (Inpatient/Outpatient)
* Laboratory Tests
* Medical Supplies
* Monitoring Devices (Nonroutine)
* Office Visits to CSHCS Authorized Physicians
* Orthopedic Shoes
* Orthotics and Prosthetics
* Parenteral Nutrition
* Pharmacy
* Physical/Occupational/Speech Therapy
* Radiological Procedures
* Respite*
* Telemedicine
* Transplants and Implants
* Vision
(* Refer to the information and authorization requirements stated in this Section.)
PARTIAL MONTH COVERAGE
If a beneficiary enters or leaves a facility that is not a covered facility (e.g., nursing facility, or intermediate care facility) during a month of eligibility, the beneficiary remains a beneficiary for the remainder of that month. However, services provided to the beneficiary while in the facility are not covered (i.e., reimbursable) by CSHCS as these facilities are responsible for providing the medical care. (Refer to the General Information for Providers Chapter in this manual for additional information for beneficiaries who also have Medicaid coverage.)
RENEWAL OF COVERAGE
The beneficiary’s coverage may be renewed as needed if all eligibility criteria continue to be met and thefamily completes the renewal process. Medical review reports are required according to the timeframes established based on the primary diagnosis for the beneficiary. An annual financial review is also required. If all of the criteria continue to be met for CSHCS coverage, a new coverage period is typically issued in 12-month increments.
