NAC442.751. Limitations of program.

The program will:

     1. Not provide for the total care of a client.

     2. Provide only services that are related to treating a client’s condition.

     3. Cover conditions with a poor or variable prognosis only as funding for the program allows.

     4. Pay not more than $10,000 annually for each client unless, subject to budgetary limitations, the Chief Medical Officer or a person designated by the Administrator authorizes the expenditure of an additional amount in an extraordinary situation.

     5. Reimburse providers at Medicaid rates for the costs of the services provided to clients. For the costs incurred for orthotic and prosthetic devices provided by medical prescription to enhance a client’s ability to perform the activities of daily living, the program will reimburse:

     (a) At Medicaid rates; or

     (b) At 80 percent of the usual and customary charge if no Medicaid rate is available.

     6. Approve services provided outside this State only when:

     (a) The services are not available within this State; and

     (b) The provider who refers the client for those services agrees to provide ongoing follow-up care to the client.

     7. Pay the costs of any diagnostic evaluations performed to determine whether a client has an eligible medical condition if the gross annual income of the client is not more than 300 percent of the level of poverty designated for a household of that size by the United States Department of Health and Human Services. For the purposes of this subsection, gross annual income will be calculated as provided in NAC 442.710.

     (Added to NAC by Bd. of Health, eff. 1-18-94; A by R212-97, 7-23-98; R095-99, 11-29-99)