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.
