1. (a) Except as otherwise described in this section, a disease, defect, or condition is eligible if in the judgment of the department the disease, defect, or condition

   1. (1) has been present for at least six months, or has been present from birth; and
   2. (2) severely impairs the child's growth or development.

2. (b) The following conditions are not eligible conditions, even if they meet the conditions described in (a) of this section:

   1. (1) acute trauma;
   2. (2) lacrimal duct obstruction;
   3. (3) mastoiditis;
   4. (4) respiratory distress syndrome;
   5. (5) congenital pyloric stenosis;
   6. (6) umbilical or inguinal hernia;
   7. (7) dental conditions;
   8. (8) hydrocele;
   9. (9) cystitis;
   10. (10) primary hypospadias that is a cosmetic defect only;
   11. (11) infections of bone or joint;
   12. (12) Caffey's Disease;
   13. (13) pectus excavatum that is a cosmetic defect only;
   14. (14) learning disorders;
   15. (15) hyperactivity;
   16. (16) minimal brain dysfunction syndrome;
   17. (17) acute meningitis, acute encephalitis and acute hemorrhage within the brain;
   18. (18) minor congenital anomalies that do not interfere with any major life function;
   19. (19) malignant tumors;
   20. (20) prematurity, complications of prematurity such as nectrotizing entercolitis, and apnea of prematurity;
   21. (21) hyaline membrane disease;
   22. (22) undescended testicles; and
   23. (23) chronic otitis media with effusion.

3. (c) The following conditions are ineligible except as described in this subsection:

   1. (1) Asthma is an eligible condition only if it is severe and interferes with

      1. (A) normal growth and development; or
      2. (B) attendance at school or work;
   2. (2) Deformity or absence of the external ear is an eligible condition only to the extent that the condition interferes with hearing. The department will not pay costs of plastic reconstruction of the external ear;
   3. (3) Refractive error which predisposes to amblyopia is an eligible condition only if suffered by a child that is no more than 8 years of age. A refractive error which is greater than minus eight diopters is an eligible condition;
   4. (4) Nephritis, pyelonephritis and glomerulonephritis are eligible conditions only if they extend beyond six months or if there have been two or more acute occurrences;
   5. (5) Pectus excavatum is an eligible condition only if it interferes with cardio-respiratory function;
   6. (6) An emotional or mental disorder is an eligible condition only if secondary to another eligible condition;
   7. (7) Short stature is an eligible condition only if the department finds that human growth hormone is deficient;
   8. (8) Chronic otitis media with perforation is an eligible condition only if the child has suffered an episode of meningitis or if the child has a disabling conductive hearing loss that has been documented, by an audiologist with a certificate of clinical competence, on two audiometric tests separated by at least three months;
   9. (9) Central apnea of an infant who is not premature is eligible only if a pneumocardiogram documents a substantial risk of sudden death.

(Eff. 6/28/85, Register 94)