(1) To the extent department funding allows, and up to a maximum of $2,000 per federal fiscal year, the department will provide financial assistance as cited in (3) for the eligible conditions listed in (2), subject to the exceptions to financial assistance and conditions in (4) and (5).

(2) Eligible conditions are:

(a) endocrine, nutritional and metabolic diseases, and immunity disorders;

(b) diseases of the blood and blood-forming organs;

(c) diagnosis only for mental disorders;

(d) diseases of the nervous system and sense organs;

(e) diseases of the circulatory system;

(f) diseases of the respiratory system;

(g) diseases of the digestive system;

(h) diseases of the genitourinary system;

(i) diseases of the skin and subcutaneous tissue;

(j) diseases of the musculoskeletal system and connective tissue;

(k) congenital anomalies;

(l) certain conditions originating in the perinatal period; and

(m) initial diagnosis evaluation for certain symptoms, signs, and ill-defined conditions.

(3) The following are covered services that may be provided, per eligibility year, to a CSHS-eligible CYSHCN:

(a) evaluation, diagnosis and treatment, including surgical correction;

(b) evaluation and outcome management of developmental delay by a developmental pediatrician;

(c) appliances required for correction of a covered condition;

(d) medical foods for the treatment of a metabolic disorder, including prescriptive supplements for a CYSHCN with inborn errors of metabolism;

(e) occupational, physical, nutrition and speech therapy for rehabilitation related to a covered service;

(f) allergy injections on the recommendation of a pediatric allergist after other preventive measures have been exhausted;

(g) hearing aids;

(h) one dental visit per eligibility year;

(i) one well child visit per eligibility year;

(j) breast pump purchase or rental (up to one year) to aid the mother of a newborn with a covered condition;

(k) corrective lenses for a CYSHCN with a medical disorder-related condition, limited to a single pair of frames per eligibility year up to a maximum of $175 for frames, lenses and evaluation, plus an additional prescription lens change in six months as needed;

(l) disposable and durable medical equipment for covered conditions;

(m) apnea monitor purchase or rental for a covered condition (up to one year);

(n) case management and care coordination;

(o) tonsillectomy and adenoidectomy in cases of obstructive sleep apnea or to protect hearing; and

(p) prescription medications related to the covered condition.

(4) No financial assistance is available for the following:

(a) acute care for illness or injury;

(b) visual training therapy;

(c) home health and home nursing services for acute cases;

(d) legal services;

(e) psychological and psychiatric care and counseling;

(f) respite care;

(g) transplants;

(h) transportation;

(i) services provided outside of Montana, unless the required service is not available in-state or, due to the vast distances within Montana, the requirement to obtain in-state services places an undue hardship on a family or has been approved by the program's medical advisor;

(j) speech, occupational, nutritional, physical or respiratory therapy for a condition that is not CSHS-eligible;

(k) treatment for cleft/craniofacial conditions that are not planned and recommended by a cleft palate team recognized by the American Cleft Palate Association (ACPA) Commission on Approval of Cleft Palate and Craniofacial Teams (CAT); and

(l) clinical trial services and medications.

(5) Conditions that are ineligible for financial assistance are:

(a) conditions which are usually non-remediable with no potential for long-term habilitation;

(b) behavioral, emotional, and learning disabilities;

(c) primary psychiatric diseases;

(d) injuries and illnesses; and

(e) catastrophic diseases, including neoplasms and other cancers.