Section 441.86.14. Covered services.

The benefits provided under the HAWK-I program shall meet a benchmark, benchmark equivalent, or benefit plan that complies with Title XXI of the federal Social Security Act.

       86.14(1) Required medical services. The participating health plan shall cover at a minimum the following medically necessary services:

        a.           Inpatient hospital services (including medical, surgical, intensive care unit, mental health, and substance abuse services).

        b.           Physician services (including surgical and medical, and including office visits, newborn care, well-baby and well-child care, immunizations, urgent care, specialist care, allergy testing and treatment, mental health visits, and substance abuse visits).

        c.           Outpatient hospital services (including emergency room, surgery, lab, and x-ray services and other services).

        d.           Ambulance services.

        e.           Physical therapy.

        f.            Nursing care services (including skilled nursing facility services).

        g.           Speech therapy.

        h.           Durable medical equipment.

        i.            Home health care.

        j.            Hospice services.

        k.           Prescription drugs.

        l.            Rescinded IAB 1/13/10, effective 3/1/10.

        m.          Hearing services.

        n.           Vision services (including corrective lenses).

       86.14(2) Abortion. Payment for abortion shall only be made under the following circumstances:

        a.           The physician certifies that the pregnant enrollee suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would place the enrollee in danger of death unless an abortion is performed.

        b.           The pregnancy was the result of an act of rape or incest.

       86.14(3) Required dental services. Participating dental plans shall cover at a minimum the following necessary dental services:

        a.           Diagnostic and preventive services.

        b.           Routine and restorative services.

        c.           Endodontic services.

        d.           Periodontal services.

        e.           Cast restorations.

        f.            Prosthetics.

[ARC 8478B, IAB 1/13/10, effective 3/1/10]