Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.30 - Outpatient Hospital Services
Rule 37.86.3002 - OUTPATIENT HOSPITAL SERVICES, SCOPE AND REQUIREMENTS
Universal Citation: MT Admin Rules 37.86.3002
Current through Register Vol. 18, September 20, 2024
(1) The requirements of ARM 37.86.2801, 37.86.2803, 37.86.3001, 37.86.3005 and this rule are in addition to those contained in rule provisions generally applicable to Medicaid providers.
(2) Outpatient hospital services are services that would also be covered by Medicaid if provided in a nonhospital setting and are limited to the following diagnostic and therapeutic services furnished by hospitals to outpatients:
(a) diagnostic services, including:
(i) the services of nurses, psychologists and
technicians;
(ii) drugs and
biologicals;
(iii) laboratory and
imaging services;
(iv)
psychological tests;
(v) supplies
and equipment; and
(vi) other tests
to determine the nature and severity of a medical condition;
(b) therapeutic services and
supplies, including:
(i) emergency room
services;
(ii) clinic services;
and
(iii) the use of hospital
facilities incident to provision of physician services to the patient where the
services and supplies are furnished in the hospital on a physician's order by
hospital personnel under the supervision of hospital medical staff;
(c) chemical dependency treatment
services;
(d) services provided
outside the hospital, as follows:
(i)
diagnostic services provided by hospital personnel outside the hospital
premises with or without direct personal supervision of a physician;
(ii) therapeutic services that are incidental
to physician services and provided under the direct personal supervision of a
physician. Outpatient physical therapy, occupational therapy, and speech
therapy are not subject to the direct physician supervision requirement.
Therapy services are limited as in ARM
37.86.606;
(e) diabetes education services provided by a
hospital whose diabetes education programs are in compliance with ARM
37.86.5401 through
37.86.5404; and
(f) lactation services performed by
nonphysician providers, i.e., certified lactation providers. These services
will only be allowed to be billed by the facility effective January 1,
2016.
AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
Disclaimer: These regulations may not be the most recent version. Montana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
