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

(a) 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

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

(2) For a child who is eligible for developmental disabilities Part H services or for developmental disabilities family and educational support general fund services and who is eligible for children with special health care needs case management, the developmental disabilities services program provides lead case management. For a child with case management services from both the developmental disabilities program and the children's special health care needs program, the case management services provided by children with special health care needs case management providers are limited to the coordination of health and medical activities only. Children with special health care needs case management providers must incorporate the health and medical care plan within the individual family service plan and provide services in accordance with ARM 37.34.601, 37.34.602, 37.34.604, 37.34.605, 37.34.609, 37.34.612 through 37.34.616, 37.34.621, 37.34.622, 37.34.2101, 37.34.2102, 37.34.2106, 37.34.2107, 37.34.2111 and 37.34.2112. Under these circumstances, children with special health care needs case management providers may bill medicaid for health and medical case management activities only.

(3) Initial assessment of children covered by these special health care needs 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.