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 37.86.3003 - OUTPATIENT HOSPITAL SERVICES, EXCLUSIONS
Universal Citation: MT Admin Rules 37.86.3003
Current through Register Vol. 18, September 20, 2024
(1) Outpatient hospital services do not include:
(a)
services excluded from coverage by the Medicaid program under ARM
37.85.207;
(b) exercise programs and programs primarily
educational in nature unless covered as preventative outpatient services,
including, but not limited to independent exercise programs, such as pool
therapy, swim programs, or health club memberships;
(c) outpatient physical therapy, occupational
therapy, and speech therapy services that are primarily maintenance therapy as
defined in ARM
37.86.601;
(d) experimental or investigational services
such as the use of off-label drugs where this usage is not a national standard
of practice, or non-FDA-approved use of drugs, biologicals, and devices;
(e) services that do not comply
with national standards of medical care; and
(f) outpatient hospital services provided
outside the borders of the United States will not be covered or reimbursed by
the Montana Medicaid program.
AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-2-201, 53-6-101, MCA
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