1. (a) The department will not pay the cost of a service unless the department finds that the service is an integral part of the proper treatment or management of an eligible condition that causes a child to have a disability.

2. (b) In accordance with (a) and except as provided in (c) of this section, the department will pay costs of only the following services:

   1. (1) diagnostic services;
   2. (2) medical and surgical services;
   3. (3) hospitalization;
   4. (4) dental and orthodontal services for an eligible condition;

   5. (5) speech therapy, as provided in (d) of this section, if

      1. (A) a speech disorder is an integral part of another disabling condition; and
      2. (B) the department determines that speech therapy is not reasonably available to a child through the public schools;
   6. (6) physical therapy, as provided in (d) of this section;
   7. (7) occupational therapy, as provided in (d) of this section;
   8. (8) evaluation, fitting, and purchase of hearing aids;
   9. (9) nutritional therapy;
   10. (10) psychological counseling and family therapy if the department determines that the counseling is not reasonably available from a community mental health agency;
   11. (11) rehabilitation equipment;
   12. (12) prescription drugs;

   13. (13) refractions, corrective lenses, and glasses, but only if corrected vision is

       1. (A) essential to a proper management of an eligible eye condition, or
       2. (B) essential to management of multiple sensory disabilities; and
   14. (14) medical foster home care for a period not to exceed three months.
3. (c) The department will arrange for and pay the cost of air transportation or surface transportation that is greater than 50 miles round trip, meals, and housing for an eligible child and for the child's parent or escort if the department finds that an eligible service is unavailable in the community where the child lives and the transportation, meals, and housing are necessary to allow the child to receive the eligible service. The department will restrict costs under this subsection to the most economical alternative that provides a medically adequate service.
4. (d) The department will authorize no more than one hour per week of out-patient physical, occupational, or speech therapy. The department will authorize provision of these therapies for no more than three months at a time. In its discretion, the department will renew authorizations for successive periods of no more than three months. The department will authorize physical and occupational therapy only if the therapy is requested by a case-responsible physician and provided by a therapist that is certified or licensed in that particular therapy discipline. The department will authorize speech therapy only if the therapy is provided by a speech pathologist who has a certificate of clinical competence in speech.
5. (e) The department will not pay the cost of replacing broken or lost glasses or rehabilitation equipment unless six calendar months have passed since the last purchase of the glasses or equipment or unless the circumstances of loss or damage are clearly beyond individual control.

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