NAC442.786. Ineligible conditions and services.

The program does not cover the following conditions and services:

     1. Acute infectious diseases.

     2. Learning disabilities, intellectual disabilities and problems related to behavior.

     3. Allergies.

     4. The alteration of a construction or dwelling.

     5. Benign inflammatory conditions.

     6. Blood and plasma, except for processing and administrative fees.

     7. Chronic sinusitis, except in cases of severe respiratory impairment.

     8. Cosmetic surgery as an isolated indication.

     9. Custodial care.

     10. Diagnostic or therapeutic procedures, techniques, instrumentalities or agents that:

     (a) Have not been approved by the Food and Drug Administration; or

     (b) Are experimental.

     11. Disorders of the immune system.

     12. Educational services.

     13. Flat feet, tibial torsion and metatarsus adductus.

     14. Hypertrophy of the tonsils and adenoids, unless the tonsils and adenoids significantly contribute to, interfere with, or complicate the management of an eligible medical condition.

     15. Initial acute care of accidents, poisoning and violence.

     16. Ordinary refractive errors.

     17. Prematurity alone.

     18. Second opinions that have not been requested by a physician of record with documentation of medical necessity.

     19. Services for homemakers.

     20. Strabismus, where nonsurgical treatment suffices.

     21. Transplant surgeries and drugs and supplies directly related to the transplant.

     22. The transportation of a client or a member of his or her household, except that transportation by ambulance is covered in unusual circumstances if it is requested in advance and there is documentation of the unusual circumstances that created the need.

     (Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98)—(Substituted in revision for NAC 442.755)