Established Conditions - PDF document

1 Early On ® Michigan Established Cond
Early On ® Michigan Established Conditions Established c onditions indicate automatic eligibility for Early On supports and services. Established conditions m ust be diagnosed by an appropriate health care or mental health provider and documented in a medical or other record (i.e., a Child Abuse Prevention and Treatment Act (CAPTA) referral that references a medical diagnosis). Conditions include but are not limited to , the following: Wednesday, June 2, 2021 1 Note: The Endocrine/Metabolic Disorders Category also includes all disorders tested for in the Michigan Newborn Screening Program. 1. Congenital Anomalies 1.1. Central Nervous System • Agenesis of the c orpus c allosum • Holoprosencephaly • Hydrocephalus w/o s pina b ifida • Microcephalus • Spina b ifida w/o a nencephaly 1.2. Eye, Ear, Face , and Neck • Craniofacial syndromes such as: o Pierre Robin s equence o Treacher Collins s yndrome • Anopthalmos • Anotia/ m icrotia • CHARGE s yndrome • Congenital c ataract • Craniosynostosis • Micropthalmos 1.3. Heart and Circulatory System • Aortic v alve a tresia and s tenosis • Coarctation of a orta • Hypoplastic l eft h eart • Patent d uctus a rteriosus (PDA) • Tetralogy of Fallot • Other serious congenital heart defects 1.4. Respiratory System • Choanal a tresia • Diaphragmatic hernia • Lung a genesis - h ypoplasia 1.5. Cleft Lip & Palate • Cleft p alate w/o c left l ip • Cleft l ip w/ and w/o c left p alate 1.6. Digestive System • Esophageal a tresia/ t racheoesophageal f istula • Gastroschisis • Hirschsprung’s d isease • Omphalocele • Pyloric s tenosis 1.7. Genital & Urinary Organs • Hypospadias and e pispadias • Renal a genesis 1.8. Musculoskeletal System • Achondroplasia • Arthrogryposis • Congenital h ip d islocation • Lower l imb r eduction d eformities • Upper l imb r eduction d eformities • Other c ongenital a nomalies of the m usculoskeletal system 1.9. Other and Unspecified • Bardet - B i edl s yndrome • Fragile X s yndrome 2. Chromosomal Anomalies • Angelman s yndrome • Cri - du - Chat s yndrome • DiGeorge s yndrome (Velo - c ardi o - f acial s yndrome) • Kleinfelter s yndrome • Prader - Willi s yndrome • Trisomy 21 (Down s yndrome) • Trisomy 13 (Patau s yndrome) • Trisomy 18 (Edward s s yndrome) • Turner s yndrome • Williams s yndrome • Other chromosomal anomalies such as micro deletions and duplications 3. Infectious Conditions 3.1. Congenital Infections • HIV/AIDS • Syphilis • TORCH: o Toxoplasmosis o Other a gents o Rubella o Cytomegalovirus o Herpes s implex • Cytomegalovirus (CMV) • Other congenital infections such as Zika 3.2. Acquired Infections • Bacterial m eningitis • Encephalitis • Poliomyelitis • Viral m eningitis 4. Endocrine/Metabolic Disorders 4.1. Mucopolysaccharidosis • Hunter s yndrome • Hurler s yndrome • Maroteaux - Lamy s yndrome • S anfilippo s yndrome • Scheie s yndrome • Sly s yndrome 4.2. Enzyme Deficiency • Biotinidase d eficiency • Medium - c hain a cyl - CoA d ehydrogenase d eficiency (MCAD) • Oculocerebrorenal s yndrome (Lowe s yndrome) Early On ® Michigan Established Conditions Established c onditions indicate automatic eligibility for Early On supports and services. Established conditions m ust be diagnosed by an appropriate health care or mental health provider and documented in a medical or other record (i.e., a Child Abuse Prevention and Treatment Act (CAPTA) referral that references a medical diagnosis). Conditions include but are not limited to , the following: Wednesday, June 2, 2021 2 Note: The Endocrine/Metabolic Disorders Category also includes all disorders tested for in the Michigan Newborn Screening Program. 4.3. Abnormalities of Amino Acid Metabolism • Arginino succinic a ciduria / Citrullinemia • Homocystinuria • Infant Phenylketonuria (PKU) • Maple s yrup u rine d isease • Methylmalonic a cidemia (MMA) • Ornithine t ranscarbamylase

2 (OTC) d eficiency 4.4. Abnormal
(OTC) d eficiency 4.4. Abnormalities of Carbohydrate Metabolism • Galactosemia • Glycogen s torage d isease • Pompe d isease 4.5. Abnormalities of Lipid Metabolism • Gaucher d isease • Niemann - Pick d isease 4.6. Abnormalities of the Purine/Pyrimidine Metabolism • Lesch Nyhan s yndrome 4.7. Abnormalities of the Parathyroid • Untreated h yperparathyroidism • Untreated h ypoparathyroidism 4.8. Abnormalities of the Pituitary • Hyperpituitary • Hypopituitary 4.9. Abnormalities of Adrenocortical Function • Congenital a drenal h yperplasia • Hyperadrenocortical f u nction • Hypoadrenocortical f unction 4.10. Hemoglobinopathies • Sickle c ell d isease • Thalassemia (major and minor) 4.11 Abnormalities of the Thyroid Hormone • Congenital h ypothyroidism 4.12. Peroxisomal Disorders • Adrenoleukodystrophy ( A LD ) • Cerebrohepatorenal s yndrome (Zellweger s yndrome) • Peroxisomal b iogenesis d isorders • Rhizomelic c hondrodysplasia p unctata 5. Other Disorders/Diseases 5.1. Neurological Disorders 5.1.a Neuromotor/Mus cle Disorders • Cerebral p alsy • Congenital m yasthenia • Kernicterus • Muscular d ystrophies • Paralysis • Periventricular l eukomalacia • Spinal m uscular a trophy • Torticollis 5.1.b. Cerebrovascular Disease • Cerebral a rterial t hrombosis • Cerebral e mbolus t hrombosis • Cerebral v enous t hrombosis 5.1.c. Brain Hemorrhages • Intracranial h emorrhage • Intraventricular h emorrhage (grades 3 & 4 ) 5.1.d. Degenerative Disorders • Acute d isseminated e ncephalomyelitis • Cockayne s yndrome • Friedreich’s a taxia • Gangliosidosis • Leigh’s d isease • Leukodystrophy • Schilder’s d isease • Tay - Sachs d isease 5.1.e. Neurocutaneous Disorders • Ectodermal d ysplasia • Incontinentia p igmenti • Neurofibromatosis • Sturge - Weber s yndrome • Tuberous s clerosis • Xeroderma p igmentosa 5.1.f. Malignancies • Intracranial t umors and o ther m alignancies of the central nervous system 5.1.g. Head and Spinal Cord Trauma • Fracture of vertebral column with or without spinal cord lesions • Shaken b aby s yndrome • Traumatic b rain i njury 5.1.h. Hypoxic/Anoxic Brain Injury • Hypoxic i schemic e ncephalopathy ( n ewborn e ncephalopathy) • Near d rowning 5.2. Vision Impairment • Amblyopia • Cortical v isual i mpairment (CVI) • Low v ision (20/7 0) • Nystagmus Early On ® Michigan Established Conditions Established c onditions indicate automatic eligibility for Early On supports and services. Established conditions m ust be diagnosed by an appropriate health care or mental health provider and documented in a medical or other record (i.e., a Child Abuse Prevention and Treatment Act (CAPTA) referral that references a medical diagnosis). Conditions include but are not limited to , the following: Wednesday, June 2, 2021 3 Note: The Endocrine/Metabolic Disorders Category also includes all disorders tested for in the Michigan Newborn Screening Program. • Retinopathy of p rematurity (ROP) ( s tage 3 - s tage 5) • Visual f ield l oss 6. Hearing Deficiency • Auditory n europathy • Bilatera l or u nilateral hearing loss of ≥ 25 dB at 2+ frequencies between 500 - 4000 Hz • Mixed h earing l oss • Permanent c onductive h earing l oss • Sensorineural h earing l oss • Waardenburg s yndrome 7. Other Fetal/Placental Anomalies • Tw in to t win t ransfusion s yndrome • Umbilical c ord p rolapse 8. Exposures Affecting Fetus/Child 8.1. Prenatal • Fetal a lcohol e xposure • Fetal d rug e xposure • Diagnosed m aternal p henylketonuria ( PKU ) 8.2. Postnatal • Lead – v enous b lood l ead level at or above reference value recommended by the CDC (currently 5 µg/dL) * • Following CDC recommendations for mercury and other neurotoxic chemicals diagnosed at elevated exposure levels *MDHHS rounds values 4.5 or greater to 5 µg/dL 9. Chronic Illness 9.1. Medically Fragile • Renal i nsufficiency 9.2.

3 Medical Illness • Bronchopulmonar
Medical Illness • Bronchopulmonary d ysplasia • Cancer • Chronic h epatitis • Connective t issue d isorders • Cystic f ibrosis • Diabetes • Immune d isorders (ex. j uvenile a rthritis) • Failure to t hrive • Renal f ailure • Very l ow b irth w eight (1500 grams or 3.3 lbs.) • Chronic a sthma – moderate to severe • Intrauterine g rowth r estriction (IUGR) • Small for g estational a ge (10% weight for age) (SGA) 10. Developmental Delay 10.1. Pervasive Developmental Disorders • Autism s pectrum d isorder • Childhood d isintegrative d isorder 10.2. Rett Syndrome 10.3. Regulatory Disorders of Sensory Processing • Hyposensitive/ h ypersensitive • Sensory s eeking/ i mpulsive 11. Mental Health Conditions • Adjustment d isorders • Depression of i nfancy and e arly c hildhood • Diagnosed r egulatory d isorders • Disorders of a ffect • Maltreatment/ d eprivation d isorder • Mixed d isorders of e motional e xpressiveness • Post - t raumatic s tress d isorder (PTSD) ��Early OnMichigan Established Conditions Established conditions indicate automatic eligibility for Early Onsupports and services. Established conditions must be diagnosed by an appropriate health care or mental health provider and documented in a medical or other record (i.e., a Child Abuse Prevention and Treatment Act (CAPTA) referral that references a medical diagnosis). Conditions include but are not limited to, the following: Wednesday, June 2, 2021 1 Note: The Endocrine/Metabolic Disorders Category also includes all disorders tested for in the Michigan Newborn Screening Program. 1. Congenital Anomalies 1.1. Central Nervous System Agenesis of the c orpus c allosum Holoprosencephaly Hydrocephalus w/o s pina b ifida Microcephalus Spina b ifida w/o a nencephaly 1.2. Eye, Ear, Face , and Neck Craniofacial syndromes such as: o Pierre Robin s equence o Treacher Collins s yndrome Anopthalmos Anotia/ m icrotia CHARGE s yndrome Congenital c ataract Craniosynostosis Micropthalmos 1.3. Heart and Circulatory System Aortic v alve a tresia and s tenosis Coarctation of a orta Hypoplastic l eft h eart Patent d uctus a rteriosus (PDA) Tetralogy of Fallot Other serious congenital heart defects 1.4. Respiratory System Choanal a tresia Diaphragmatic hernia Lung a genesis - h ypoplasia 1.5. Cleft Lip & Palate Cleft p alate w/o c left l ip Cleft l ip w/ and w/o c left p alate 1.6. Digestive System Esophageal a tresia/ t racheoesophageal f istula Gastroschisis Hirschsprung’s d isease Omphalocele Pyloric s tenosis 1.7. Genital & Urinary Organs Hypospadias and e pispadias Renal a genesis 1.8. Musculoskeletal System Achondroplasia Arthrogryposis Congenital h ip d islocation Lower l imb r eduction d eformities Upper l imb r eduction d eformities Other c ongenital a nomalies of the m usculoskeletal system 1.9. Other and Unspecified Bardet - B i edl s yndrome Fragile X s yndrome 2. Chromosomal Anomalies Angelman s yndrome Cri - du - Chat s yndrome DiGeorge s yndrome (Velo - c ardi o - f acial s yndrome) Kleinfelter s yndrome Prader - Willi s yndrome Trisomy 21 (Down s yndrome) Trisomy 13 (Patau s yndrome) Trisomy 18 (Edward s s yndrome) Turner s yndrome Williams s yndrome Other chromosomal anomalies such as micro deletions and duplications 3. Infectious Conditions 3.1. Congenital Infections HIV/AIDS Syphilis TORCH: o Toxoplasmosis o Other a gents o Rubella o Cytomegalovirus o Herpes s implex Cytomegalovirus (CMV) Other congenital infections such as Zika 3.2. Acquired Infections Bacterial m eningitis Encephalitis Poliomyelitis Viral m eningitis 4. Endocrine/Metabolic Disorders 4.1. Mucopolysaccharidosis Hunter s yndrome Hurler s yndrome Maroteaux - Lamy s yndrome S anfilippo s yndrome Scheie s yndrome Sly s yndrome 4.2. Enzyme Deficiency Biotinidase d eficiency Medium - c hain a cyl - CoA d ehydrogenase d eficiency (MCAD) Oculocerebrorenal s yndrome (Lowe s yndrom