PURPOSE: This rule defines the medical conditions for which MCCS will provide service and funding.

1. (1) Category I shall include those eligible applicants whose medical conditions require immediate lifesaving medical treatment. The conditions include, but are not necessarily limited to:

   1. (A) Bum care--any burns requiring seven

2. (7) days or more inpatient care and burns requiring skin grafting;

   1. (B) Cardiac care-congenital heart disease requiring surgical intervention or presenting with congestive heart failure; and acute rheumatic fever with congestive heart failure or requiring cardiac surgery;
   2. (C) Cleft lip and palate care-initial lip or palate closure or both;
   3. (D) Genito-urinary (GU) care-bladder extrophy! vesico-ureteral r&x and ureteropelvie junmon obstruction;
   4. (E) Myelomeningocele care (spina bifida)- surgical closure of myelocele; (Fj Neurology care-depressed skull fracture, subdural hematoma and uncontrolled seizures;
   5. (C) Neurosurgery care-shunting procedures;

   6. (H) Orthopedic care-acquired amp&+ tions, fractures and fracture dislocations of the vertebral column with or without associated

      COOEOFSTATE REGUtATlONS

spinal cord injury except for closed coccygeal fractures, open fractures, osteogenesis imperfeda, osteomyelitis or pyarthrosis presenting with sepsis; and

1. (I) Pediatric surgery care-diaphragm&c hernia with accompanying respiratory distress; Hirschsprung’s disease; multiple surgically-staged imp&orate anus; duodenal at&a; jejunal at&a; tracheoesophageal fistula; gastroschisis; omphalocele; intestinal obstruction in neonates; lacerated tendons; electrical bums to the mouth; surgical prow dures for subglottic stenosis; laryngeal webs; choanal atresia; and ingestion bums; and
2. (J) The following are not covered under Category I: arthritis care; cerebral palsy care; ear; nose and treat (EN’l’&aring care; ENT/ surgical care; and physical, medical and rehabilitation (PM&R) care.

1. (2) Category II shall include those medical conditions which, if not treated, could grow worse or cause a crippling disability. A limited txrm of hospitalization and a good prognosis should be expected. The conditions may include, but are not necessarily limited to:

   1. (A) Arthritis care-acute juvenile rheumatoid arthritis;
   2. (B) Bum care-follow-up and rehabilitation services;
   3. (C) Cardiac care-congenital heart disease

2. (CHD) not requiring immediate surgical intervention and CHD not presenting with congestive heart failure;

   1. (D) Cerebral palsy care-surgical procedures and bracing;
   2. (E) Cleft lip and palate care-surgical procedures; WI Ear. nose and throat (ENT) sureical ca&u&ical procedures fo; chr&ic &tis media, tympanic membrane perforation, cholesteatoma and other otologic conditions requiring specialty care;
   3. (G) Genito-urinary care-bladder exstrophy, vesicoureteral r&x, utreteropelvic junction obstruction, hypospadias and ambiguous genitalia;
   4. (H) Myelomeningocele care(spinalbifida)- follow-up and rehabilitation services:
   5. (I) Neurology care-residuals of meningitis, Guillain-Barre syndrome( R&s syndrome, poliomyelitis, seizure disorders and stalic encephalopathies;
   6. (J) Neurosurgery care-hydrocephanlus, diastematomyelia, enecephalocele and vascular lesions affecting the central nervo”~ SJVk”l;

   7. (K) Orthopedic care-congenital deformities: arthrogryposis congenital dysplasia of the hip ; complicated fractures of the limbs, oelvis and shoulder girdle: scoliosis and kyphosis; surgical treat&t bf late effects of epiphyseal injury; osteomyelitis; closed spinal

      (4/19/91) Roy 0. Blunt serretary Of state

Chapter l-Crippled Children’s Service (CCS)

fracture without neurologic deficit, excluding coccygeal fractures; rickets; Legg-Calve- Perthes disease; club feet; nonmalignant bone tumors and acquired injury to limbs;

1. (L) Pediatric surgery care-benign tumors, hemangiomas, lymphangiomas and neurofibromas which cause functional impairment or disfigurement and surgical correction of laryngeal papillomas;
2. (M) Physical, medical and rehabilitation (PM&R) care-rehabilitation for spinal cord injuries; and
3. (N) The following are not covered under Category II: ear, nose and throat (ENT)/

1. (3) Category III shall include those eligible applicants whose conditions may require prolonged outpatient care and may require hospitalization at some time. The conditions have a fair prognosis if treated and may include, but are not necessarily limited to:

   1. (A) Arthritis care-juvenile sheumatoid arthritis follow-up as needed;
   2. (B) Bum care-covered under Category I and II;
   3. (C) Cardiac care-congenital heart disease follow-up and resistant dysrhythmias; ,
   4. (D) Cerebral palsy care-rehabilitation **IViCeS;
   5. (E) Cleft lip and palate care--surgical revisions, dental care and speech therapy;
   6. (F) Ear, nose and throat (ENl’)/hearing care-all eligible services;
   7. (G) Ear, nose and throat (ENT)/surgical care-surgical care follow-up;
   8. (H) Genitourinary care-follow-up care as needed;
   9. (I) Myelomeningocele care-covered under Categories I and II;
   10. (J) Neurology care-residuals ofmeningitis, seizure disorders, Guillain-Barre syndrome, Reye’s syndrome, poliomyelitis and stalic encephalopathies;
   11. (K) Neurosurgery care-hydrocephalus, diastematomyelia, encephalocele and vascular lesions affectine the central nervous system;
   12. (L) Orthopedic care-claw foot, calcaneovalgus and other acquired congenital deformities and rehabilitation services;
   13. (M) Pediatric surgery care-follow-up care as needed; and
   14. (N) Physical, medical and rehabilitation (PM&R) care-covered under Category II.

2. (4) Category IV shall include those eligible applicants whose medical conditions have a poor to fair prognosis or uncertain restoration ,.., to a useful or productive life regardless of the treatment provided. The conditions are considered to be maintained by the services that are provided for them and thus are put in this

   Roy D. Blunt seCl8bry Of state

category of maintenance. This is primarily * category of case management and covers the entire spectrum of CCS-eligible conditions.

1. (5) Category V shall include all those eligible applicants whose medical conditions have variable prognosis; enhancement allows improvements in activities of daily living (ADL), physical appearance for psychological reasons, with plastic surgical procedures, etc. This also includes exotic conditions such as craniofacial anomalies which are not ordinarily eligible for CCS services due to budgetary limitations; if funding allows, these conditions would be included under this category. Cosmesis, inborn errors of metabo lism, exotic drugs and special counseling are some of the miscellaneous items that would be funded in this category.
2. (6) The categories in sections (l)-(5) of this (6) The categories in sections (l)-(5) of this rule may have funding ceilings or limitations rule may have funding ceilings or limitations imposed on them or may be categoriimposed on them or may be categorically suspended, as stipulated in 19 CSR cally suspended, as stipulated in 19 CSR 40-1.060(1)(B). 40-1.060(1)(B). Auth: sections 192.005.2. and 201.060, RSMo (1986). This rule um previously filed 13 CSR 50-160.030. Emergency rule filed Dec. 12,1984, effective Dec. 22,1984, expired April 20,1985. Original rule filed Dec. 12, 1984, effective April 11, 1985. Emergency amendment filed Feb. 20, 1985, effective March 2, 1985, expired June 30, 1985. Emergency amendment filed April 11, 1985, effective April 21, 1985, expired June 30, 1985. Amended: FiledJune2,1987,effectiueAug. 13,198X