Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.31 - Outpatient Hospital Rehabilitation and Therapy Services
Rule 37.86.3105 - OUTPATIENT HOSPITAL SERVICES, PULMONARY REHABILITATION SERVICES
Universal Citation: MT Admin Rules 37.86.3105
Current through Register Vol. 24, December 20, 2024
(1) Pulmonary rehabilitation services are limited to members with moderate to severe COPD, defined as GOLD classification II, III, and IV
(2) If applicable, the patient must have ceased smoking or be in a smoking cessation class.
(3) The following pulmonary rehabilitation services are not covered:
(a) education,
treatment, and therapies that are not individualized to a specific patient need
or are not an integral part of the treatment session;
(b) routine psychological screening and
treatment where intervention is not indicated;
(c) films/videos;
(d) duplicate services;
(e) maintenance care when there is no
expectation of further improvement;
(f) treatment that is not medically necessary
because the patient requires a general strengthening and endurance program
only; and
(g) treatment that is not
medically necessary because the patient is at an early stage of pulmonary
disease as demonstrated by a lack of significant findings in diagnostic
testing.
AUTH: 53-2-201, 53-6-111, MCA; IMP: 53-2-201, 53-6-101, MCA
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