Ind. Admin. Code tit. 410, r. 3.2-7-3 – Limited health care services included in the health care service package

Sec. 3. (a) The availability and provision of health care services included in the limited service component is contingent upon the availability of program funding.

(b) Available funds may be utilized to purchase insurance or pay for one (1) or more of the following health care services authorized as appropriate to the eligible medical condition or conditions of an enrolled child:

(1) Inpatient services.
(2) Emergency services.
(3) Durable equipment and supplies.
(4) X-rays and laboratory services.
(5) Surgery.
(6) Dental services.
(7) Therapy. Payment of applied behavioral analysis as a therapy service for treatment of autism is limited to a maximum of ten thousand dollars ($10,000) per year, per participant.

(c) The CSHCN program shall only provide or pay for health care services or insurance set forth in subsection (a) or (b) if the director has approved the health care services as necessary or appropriate for the conditions, as listed under subsection (d), (e), or (f).

(d) Level I eligible medical conditions are defined in 410 IAC 3.2-6-2 and shall include the following:

(1) Apnea.
(2) Arthritis.
(3) Asthma.
(4) Autism.
(5) Bilateral hearing loss.
(6) Epilepsy.
(7) Hydrocephalus.
(8) Neuromuscular dysfunction.

(e) Level II eligible medical conditions are defined in 410 IAC 3.2-6-2 and shall include the following:

(1) Cerebral palsy.
(2) Chromosomal disorders.
(3) Cleft lip or palate, or both.
(4) Congenital or acquired developmental deformities.
(5) Endocrine deficiencies.
(6) Inborn errors of metabolism.
(7) Hemophilia.
(8) Inflammatory bowel disease.

(f) Level III eligible medical conditions are defined in 410 IAC 3.2-6-2 and shall include the following:

(1) Chronic anemia.
(2) Chronic pulmonary disease.
(3) Congenital heart disease or arrhythmias.
(4) Cystic fibrosis.
(5) Myelodysplasia or spinal cord dysfunction.
(6) Oncologic diseases.
(7) Progressive or chronic renal disease.

(g) The director shall have the authority to determine medical eligibility and the services or insurance to be provided under the program.

(Indiana Department of Health; 410 IAC 3.2-7-3; filed Apr 12, 1993, 5:00 p.m.: 16 IR 2180; readopted filed Jul 11, 2001, 2:23 p.m.: 24 IR 4234; readopted filed May 22, 2007, 1:44 p.m.: 20070613-IR-410070141RFA; filed Sep 29, 2009, 3:23 p.m.: 20091028-IR-410090001FRA, eff Jan 1, 2010; readopted filed Sep 11, 2013, 3:19 p.m.: 20131009-IR-410130346RFA; readopted filed Nov 13, 2019, 3:14 p.m.: 20191211-IR-410190391RFA; readopted filed Nov 14, 2025, 11:18 a.m.: 20251210-IR-410240588RFA)