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. 18, September 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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