44:06:06:01.  Chronic medical conditions covered. Chronic medical conditions which may be covered for an eligible individual include the following:

 

          (1)  Genetics:

 

               (a)  Multiple anomaly syndromes;

               (b)  Genetic conditions; and

               (c)  Chromosomal disorders;

 

          (2)  Cardiology:

 

               (a)  Cyanotic heart disease;

               (b)  Acyanotic heart disease;

               (c)  Cardiomyopathies and pericarditis;

               (d)  Rheumatic heart disease;

               (e)  Arrythmias;

               (f)  Systemic hypertension;

               (g)  Kawasaki disease; and

               (h)  Other cardiac conditions which are complex and chronic;

 

          (3)  Gastroenterology:

 

               (a)  Malabsorption syndrome/disorders;

               (b)  Inflammatory bowel disease/ulcerative colitis;

               (c)  Congenital abnormalities of gastrointestinal tract, excluding pyloric stenosis and umbilical or femoral/inguinal hernias;

               (d)  Esophageal reflux; and

               (e)  Other gastrointestinal conditions which are complex and chronic;

 

          (4)  Pulmonary:

 

               (a)  Cystic fibrosis;

               (b)  Asthma;

               (c)  Bronchopulmonary dysplasia;

               (d)  Pectus excovatum;

               (e)  Tracheo - esophageal Fistula (with or without reflux); and

               (f)  Other pulmonary conditions which are complex and chronic;

 

          (5)  Craniofacial anomalies:

 

               (a)  Cleft lip and palate; and

               (b)  Other congenital craniofacial anomalies that are complex and chronic;

 

          (6)  Endocrinology:

 

               (a)  Thyroid malfunction;

               (b)  Delayed adolescence;

               (c)  Parathyroid malfunction;

               (d)  Sexual precocity;

               (e)  Pituitary tumors;

               (f)  Inborn errors of metabolism;

               (g)  Diabetes mellitus or insipidus; and

               (h)  Other endocrine conditions which are complex and chronic;

 

          (7)  Hematology/hemophilia/oncology:

 

               (a)   Chronic anemia;

               (b)  Neutropenias;

               (c)  Leukemias;

               (d)  Clotting disorders;

               (e)  Solid tumors;

               (f)  Hemophilia A;

               (g)  Hemophilia B; and

               (h)  Other hematology/oncology conditions which are complex and chronic;

 

          (8)  Children's rehabilitation:

 

               (a)  Congenital hydrocephalus;

               (b)  Myelomeningocele;

               (c)  Juvenile rheumatoid arthritis;

               (d)  Scoliosis;

               (e)  Congenital dislocation of the hip;

               (f)  Slipped capital femoral epiphysis;

               (g)  Club foot; and

               (h)  Other multiple physical disabilities which are complex and chronic;

 

          (9)   Neurology:

 

               (a)  Congenital anomalies of the central nervous system;

               (b)  Seizure disorders;

               (c)  Chronic neuromuscular disorders;

               (d)  Cerebral palsy; and

               (e)  Other neurological disorders which are complex and chronic;

 

          (10)  Renal:

 

               (a)  Chronic glomerulonephritis;

               (b)  Nephrosis;

               (c)  Chronic renal tubular disease;

               (d)  Congenital anomalies of the urinary tract; and

               (e)  Chronic renal disease resulting from structural abnormalities of urinary tract;

 

          (11)  Ophthalmology:

 

               (a)  Severe myopia;

               (b)  Strabismus;

               (c)  Congenital cataracts;

               (d)  Glaucoma; and

               (e)  Amblyopia.

 

          Source: 6 SDR 93, effective July 1, 1980; 8 SDR 155, effective May 27, 1982; 9 SDR 162, effective June 20, 1983; 14 SDR 182, effective July 11, 1988; 20 SDR 91, effective December 19, 1993; 23 SDR 91, effective December 9, 1996; 30 SDR 198, effective June 23, 2004; 33 SDR 106, effective December 26, 2006.

          General Authority: SDCL 34-1-21.

          Law Implemented: SDCL 34-1-21.

 

          44:06:06:03.  Diagnostic and consultation services covered. Diagnostic and consultation services coverable through CSHS include those scientific medical methods necessary to establish the cause and nature of a child's chronic medical condition by use of a medical examination and tests to determine a definitive diagnosis and possible treatment.

 

          Source: 6 SDR 93, effective July 1, 1980; 8 SDR 155, effective May 27, 1982; 9 SDR 162, effective June 20, 1983; 14 SDR 182, effective July 11, 1988; 20 SDR 91, effective December 19, 1993; 23 SDR 91, effective December 9, 1996; 30 SDR 198, effective June 23, 2004; 33 SDR 106, effective December 26, 2006.

          General Authority: SDCL 34-1-21.

          Law Implemented: SDCL 34-1-21.

 

          44:06:06:04.  Treatment services covered. Repealed.

 

          Source: 6 SDR 93, effective July 1, 1980; 8 SDR 155, effective May 27, 1982; 9 SDR 162, effective June 20, 1983; 14 SDR 182, effective July 11, 1988; 20 SDR 91, effective December 19, 1993; 23 SDR 91, effective December 9, 1996; 30 SDR 198, effective June 23, 2004; repealed, 33 SDR 106, effective December 26, 2006.

 

          44:06:06:07.  Services and conditions not covered. Services and conditions not covered under the CSHS program include the following:

 

          (1)  Doctor visits for routine care unless recommended by the specialist in charge;

          (2)  Routine dental care, except for that requested by an orthodontist for a child with a cleft palate;

          (3)  Surgical procedures with any associated hospitalizations except upon individual case review;

          (4)  Cosmetic surgery except upon individual case review for cleft lip or palate or both;

          (5)  Acute accidents or illnesses;

          (6)  Vocational rehabilitation;

          (7)  Special education;

          (8)  Appliance repairs;

          (9)  Room and board;

          (10)  Ambulance charges;

          (11)  Supplies and appliances as follows:

 

               (a)   Artificial eyes;

               (b)   Catheters except for renal disorders;

               (c)   Contact lenses except upon individual case review for congenital cataracts;

               (d)   Crutches;

               (e)   Over-the-counter drugs and medications, except upon individual case review;

               (f)    Glasses;

               (g)   Hearing aids, except upon individual review;

               (h)   Immunizations;

               (i)    Kidney dialysis machines;

               (j)    Prosthesis, except upon individual review;

               (k)   Shoes;

               (l)    Special beds;

               (m)  Speech appliances except for obturators;

               (n)   Walkers;

               (o)   Wheelchairs; and

               (p)   Dietary supplements, except upon individual case review;

 

          (12)  Infectious diseases;

          (13)  Organ transplants;

          (14)  Fractures or other acute trauma;

          (15)  Kidney dialysis;

          (16)  Undescended testicles;

          (17)  Intestinal obstruction;

          (18)  Imperforate anus;

          (19)  Experimental procedures; and

          (20)  Psychological evaluations.

 

          Source: 6 SDR 93, effective July 1, 1980; 8 SDR 155, effective May 27, 1982; 9 SDR 162, effective June 20, 1983; 14 SDR 182, effective July 11, 1988; 20 SDR 91, effective December 19, 1993; 23 SDR 91, effective December 9, 1996; 30 SDR 198, effective June 23, 2004; 33 SDR 106, effective December 26, 2006; 34 SDR 93, effective October 17, 2007.

          General Authority: SDCL 34-1-21.

          Law Implemented: SDCL 34-1-21.