(1) A child is eligible for targeted case management services for children and youth with special health care needs if:

(a) the child is receiving Medicaid or is presumptively eligible for Medicaid;

(b) the child:

(i) is birth through 18 years of age;

(ii) is diagnosed with special health care needs or at risk for chronic physical, developmental, behavioral, or emotional conditions; and

(iii) requires health and related services of a type or amount beyond that required by children of the same age; or

(c) the child is born to a woman who received targeted case management services as a high risk pregnant woman.

(2) The member is not eligible for targeted case management services if enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program (HIP).

(3) Initial assessment of children covered by these special health care needs targeted case management services may occur in the hospital following the infant's birth. This assessment must be followed by a referral to appropriate service providers in the community. Assessments by all professionals will be accepted, shared, and integrated into planning for all children covered by these services.