Current through Register Vol. 18, September 20, 2024
(1) These
requirements are in addition to those contained in rule provisions generally
applicable to Medicaid providers.
(2) Except as otherwise permitted by federal
law, inpatient hospital services must be ordered by a physician or dentist
licensed under state law.
(3)
Inpatient hospital services include:
(a) bed
and board;
(b) nursing services and
other related services;
(c) use of
hospital facilities;
(d) medical
social services;
(e) drugs,
biologicals, supplies, appliances, and equipment;
(f) other diagnostic or therapeutic items, or
services provided in the hospital and not specifically excluded in ARM
37.85.207; and
(g) medical or surgical services provided by
interns or residents-in-training in hospitals with teaching programs approved
by the Council on Medical Education of the American Medical Association, the
Bureau of Professional Education of the American Osteopathic Association, the
Council on Dental Education of the American Dental Association or the Council
on Podiatry Education of the American Podiatry Association.
(4) Clinical trials are limited
to:
(a) Medicaid coverage of routine costs
plus reasonable and necessary items and services used to diagnose and treat
complications arising from participation in all qualifying clinical
trials;
(b) trials that are
directly funded or supported by centers or cooperating groups funded by the
National Institutes of Health (NIH), Center for Disease Control (CDC), Agency
for Healthcare Research and Quality (AHRQ), Department of Defense (DOD), or the
Veterans Administration (VA); and
(c) clinical trial drugs, devices, and
procedures are not reimbursable
(5) Inpatient hospital services provided
outside the borders of the United States will not be reimbursed by the Montana
Medicaid program.
(6) Inpatient
hospital providers must comply with the applicable conditions of participation
for hospitals as authorized in 42 CFR 482.
(7) Acute care psychiatric hospitals must
comply with
42 CFR
440.160, 42 CFR 441 subpart D, and the
applicable conditions of participation for hospitals as authorized in 42 CFR
482.
(8) Effective July 1, 2014,
all hospitals that perform deliveries must have a hard stop policy regarding
early elective deliveries and nonmedically necessary cesarean sections. The
policy must have the following parts:
(a) no
nonmedically necessary inductions or cesarean sections prior to 39 weeks and
0/7 days gestation, and no nonmedically necessary cesarean sections at any
gestation;
(b) confirmation of
weeks gestation must be determined by the American Congress of Obstetricians
and Gynecologists guidelines. At least one of the following guidelines must be
met:
(i) fetal heart tones must have been
documented for 20 weeks by nonelectronic fetoscope or 30 weeks by
doppler;
(ii) 36 weeks since a
positive serum or urine pregnancy test that was performed by a reliable
laboratory; or
(iii) an ultrasound
prior to 20 weeks gestation that confirms the gestational age of at least 39
weeks.
(c) if pregnancy
care was not initiated prior to 20 weeks gestation, the gestational age may be
documented from first day of the last menstrual period (LMP); and
(d) a multistep review process prior to all
inductions and cesarean sections, including a requirement that the final
decision be made by the perinatology chair/obstetrical chair, OB director, or
medical director.
AUTH:
53-2-201,
53-6-113,
MCA; IMP:
53-2-201,
53-6-101,
53-6-111,
53-6-113,
53-6-141,
MCA
