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Rule Chapter: 37.86
Chapter Title: MEDICAID PRIMARY CARE SERVICES
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37.86 : MEDICAID PRIMARY CARE SERVICES


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Rule No. Rule Title Latest
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Effective
Date
Subchapter 1
Physician Services
37.86.101 PHYSICIAN SERVICES, DEFINITIONS access file 7/1/2014
Rules 37.86.102 and 37.86.103 reserved
37.86.104 PHYSICIAN SERVICES, REQUIREMENTS access file 1/1/2013
37.86.105 PHYSICIAN SERVICES, REIMBURSEMENT/GENERAL REQUIREMENTS AND MODIFIERS access file 7/1/2014
Rules 37.86.106 and 37.86.107 reserved
37.86.108 MENTAL HEALTH SERVICES PLAN, APPLICATION FORMS, INCOME VERIFICATION access file 1/12/2001
Rule 37.86.109 reserved
37.86.110 MENTAL HEALTH SERVICES PLAN, ELIGIBILITY REDETERMINATIONS, MEMBERS REQUIRED TO NOTIFY DEPARTMENT OF CHANGES, REPAYMENT OF BENEFITS access file 1/12/2001
Rule 37.86.111 reserved
37.86.112 MENTAL HEALTH SERVICES PLAN, EMERGENCY MENTAL HEALTH SERVICES, LIABILITY FOR FAILURE TO COMPLETE APPLICATION access file 1/12/2001
Subchapter 2
Mid-level Practitioner Services
37.86.201 MID-LEVEL PRACTITIONER SERVICES, REQUIREMENTS access file 2/11/1994
37.86.202 MID-LEVEL PRACTITIONER SERVICES, DEFINITIONS access file 1/1/2013
Rules 37.86.203 and 37.86.204 reserved
37.86.205 MID-LEVEL PRACTITIONER SERVICES, REQUIREMENTS AND REIMBURSEMENT access file 7/1/2013
Subchapter 5
Podiatry Services
37.86.501 PODIATRY SERVICES, DEFINITIONS access file 1/1/2013
Rules 37.86.502 through 37.86.504 reserved
37.86.505 PODIATRY SERVICES, REQUIREMENTS access file 3/31/2000
37.86.506 PODIATRY SERVICES, REIMBURSEMENT access file 1/1/2007
Subchapter 6
Therapy Services
37.86.601 THERAPY SERVICES, DEFINITIONS access file 3/13/1998
Rules 37.86.602 through 37.86.604 reserved
37.86.605 THERAPY SERVICES, PROVIDER REQUIREMENTS access file 3/13/1998
37.86.606 THERAPY SERVICES, SERVICE REQUIREMENTS AND RESTRICTIONS access file 5/9/2003
Rules 37.86.607 through 37.86.609 reserved
37.86.610 THERAPIES, REIMBURSEMENT access file 7/1/2014
Subchapter 7
Audiology Services
37.86.701 AUDIOLOGY SERVICES, PROVIDER REQUIREMENTS access file 6/21/1996
37.86.702 AUDIOLOGY SERVICES, SERVICE REQUIREMENTS, AND RESTRICTIONS access file 10/28/2011
Rules 37.86.703 and 37.86.704 reserved
37.86.705 AUDIOLOGY SERVICES, REIMBURSEMENT access file 7/1/2014
Subchapter 8
Hearing Aid Services
37.86.801 HEARING AID SERVICES, DEFINITIONS access file 10/28/2011
37.86.802 HEARING AID SERVICES, REQUIREMENTS, AND LIMITATIONS access file 10/28/2011
Rules 37.86.803 and 37.86.804 reserved
37.86.805 HEARING AID SERVICES, REIMBURSEMENT access file 7/1/2014
Subchapter 9
reserved
Subchapter 10
Dental Services
37.86.1001 DENTAL SERVICES, DEFINITIONS access file 7/1/2009
37.86.1002 DENTAL SERVICES, REQUIREMENTS access file 7/2/1999
Rule 37.86.1003 reserved
37.86.1004 REIMBURSEMENT METHODOLOGY FOR RESOURCE BASED RELATIVE VALUE FOR DENTISTS (RVD) access file 7/1/2013
37.86.1005 DENTAL SERVICES, REIMBURSEMENT access file 7/1/2014
37.86.1006 DENTAL SERVICES, COVERED PROCEDURES access file 7/1/2013
Subchapter 11
Outpatient Drug Services
37.86.1101 OUTPATIENT DRUGS, DEFINITIONS access file 11/11/2011
37.86.1102 OUTPATIENT DRUGS, REQUIREMENTS access file 11/11/2011
37.86.1103 OUTPATIENT DRUGS, FRAUD, WASTE, AND ABUSE access file 7/1/2014
Rule 37.86.1104 reserved
37.86.1105 OUTPATIENT DRUGS, REIMBURSEMENT access file 11/15/2013
37.86.1106 CALCULATION OF THE STATE MAXIMUM ALLOWABLE CHARGE, THE ESTIMATED ACQUISITION CHARGE, AND PROVIDER'S USUAL AND CUSTOMARY CHARGE access file 11/11/2011
37.86.1111 OPPORTUNITY FOR HEARING access file 1/1/2009
Subchapter 12
Birth Attendant Services
37.86.1201 BIRTH ATTENDANT SERVICES access file 7/1/2014
Subchapter 14
Ambulatory Surgical Centers
37.86.1401 CLINIC SERVICES, DEFINITIONS access file 7/1/2014
37.86.1402 CLINIC SERVICES, REQUIREMENTS access file 7/1/2014
Rules 37.86.1403 and 37.86.1404 reserved
37.86.1405 CLINIC SERVICES, COVERED PROCEDURES access file 7/1/2014
37.86.1406 CLINIC SERVICES, REIMBURSEMENT access file 7/1/2014
Subchapter 15
Home Infusion Therapy Services
37.86.1501 HOME INFUSION THERAPY SERVICES, DEFINITIONS access file 7/1/2012
37.86.1502 HOME INFUSION THERAPY SERVICES, PROVIDER REQUIREMENTS access file 7/1/2012
Rules 37.86.1503 and 37.86.1504 reserved
37.86.1505 HOME INFUSION THERAPY SERVICES, REQUIREMENTS access file 10/4/1996
37.86.1506 HOME INFUSION THERAPY SERVICES, REIMBURSEMENT access file 7/1/2013
Subchapter 16
reserved
Subchapter 17
Family Planning Services
37.86.1701 FAMILY PLANNING SERVICES access file 1/1/2013
Rules 37.86.1702 through 37.86.1704 reserved
37.86.1705 FAMILY PLANNING SERVICES, REQUIREMENTS access file 5/1/2012
37.86.1706 FAMILY PLANNING SERVICES, REIMBURSEMENT access file 5/1/2012
Subchapter 18
Prosthetic Devices, Durable Medical Equipment, and Medical Supplies
37.86.1801 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, DEFINITIONS access file 1/1/2009
37.86.1802 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, GENERAL REQUIREMENTS access file 7/1/2013
Rules 37.86.1803 through 37.86.1805 reserved
37.86.1806 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, REIMBURSEMENT REQUIREMENTS access file 1/1/2008
37.86.1807 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, FEE SCHEDULE access file 7/1/2013
Subchapter 19
reserved
Subchapter 20
Optometric Services
37.86.2001 OPTOMETRIC SERVICES, DEFINITIONS access file 7/22/1997
37.86.2002 OPTOMETRIC SERVICES, REQUIREMENTS access file 7/22/1997
Rules 37.86.2003 and 37.86.2004 reserved
37.86.2005 OPTOMETRIC SERVICES, REIMBURSEMENT access file 7/1/2014
Subchapter 21
Eyeglass Services
37.86.2101 EYEGLASSES, DEFINITIONS access file 7/22/1997
37.86.2102 EYEGLASSES, SERVICES, REQUIREMENTS AND RESTRICTIONS access file 3/13/1998
Rules 37.86.2103 and 37.86.2104 reserved
37.86.2105 EYEGLASSES, REIMBURSEMENT access file 7/1/2010
Subchapter 22
Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT)
37.86.2201 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , PURPOSE, ELIGIBILITY, AND SCOPE access file 6/27/2003
Rules 37.86.2202 through 37.86.2204 reserved
37.86.2205 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , REQUIRED SCREENING AND PREVENTIVE SERVICES access file 11/9/2007
37.86.2206 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , MEDICAL AND OTHER SERVICES access file 7/1/2013
37.86.2207 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT (EPSDT) SERVICES, REIMBURSEMENT access file 7/1/2013
Rule 37.86.2208 reserved
37.86.2209 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , NUTRITION SERVICES access file 1/12/2001
Rule 37.86.2210 reserved
37.86.2211 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , CHIROPRACTIC SERVICES access file 1/12/2001
Rule 37.86.2212 reserved
37.86.2213 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , OUTPATIENT CHEMICAL DEPENDENCY TREATMENT SERVICES REP 4/25/2003
Rules 37.86.2214 through 37.86.2216 reserved
37.86.2217 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), PRIVATE DUTY NURSING SERVICES access file 7/28/2006
Rule 37.86.2218 reserved
37.86.2219 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , THERAPEUTIC YOUTH GROUP HOME SERVICES REP 1/15/2011
Rule 37.86.2220 reserved
37.86.2221 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , THERAPEUTIC FAMILY CARE TREATMENT SERVICES REP 1/15/2011
Rules 37.86.2222 and 37.86.2223 reserved
37.86.2224 EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT SERVICE (EPSDT), COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT REP 7/1/2013
37.86.2225 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), CSCT PROGRAM BILLING REP 7/1/2013
Rules 37.86.2226 through 37.86.2229 reserved
37.86.2230 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), SCHOOL-BASED HEALTH RELATED SERVICES access file 7/1/2013
37.86.2231 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , ELIGIBILITY AND SCOPE OF SCHOOL BASED HEALTH RELATED SERVICES access file 6/27/2003
37.86.2232 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , SCHOOL BASED PERSONAL CARE PARAPROFESSIONAL SERVICES access file 6/27/2003
37.86.2233 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , SCHOOL PSYCHOLOGIST SERVICES access file 6/27/2003
37.86.2234 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , SCHOOL-BASED SPECIALIZED TRANSPORTATION SERVICES access file 1/1/2004
37.86.2235 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), ORIENTATION AND MOBILITY SPECIALIST SERVICES access file 7/1/2013
Subchapter 23
reserved
Subchapter 24
Transportation Services
37.86.2401 TRANSPORTATION AND PER DIEM, DEFINITIONS access file 11/9/2012
37.86.2402 TRANSPORTATION AND PER DIEM, REQUIREMENTS access file 10/1/2008
Rules 37.86.2403 and 37.86.2404 reserved
37.86.2405 TRANSPORTATION AND PER DIEM, REIMBURSEMENT access file 7/1/2013
Subchapter 25
Specialized Nonemergency Medical Transportation
37.86.2501 SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, DEFINITIONS access file 11/9/2012
37.86.2502 SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, REQUIREMENTS access file 6/13/2003
Rules 37.86.2503 and 37.86.2504 reserved
37.86.2505 SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, REIMBURSEMENT access file 7/1/2013
Subchapter 26
Ambulance Services
37.86.2601 AMBULANCE SERVICES, DEFINITIONS access file 6/13/2003
37.86.2602 AMBULANCE SERVICES, REQUIREMENTS access file 7/28/2006
Rule 37.86.2603 reserved
37.86.2604 AMBULANCE SERVICES, COVERAGE AND BILLABLE SERVICES access file 7/6/2001
37.86.2605 AMBULANCE SERVICES, REIMBURSEMENT access file 7/1/2014
37.86.2606 AMBULANCE SERVICES, QUALIFIED RATE ADJUSTMENT, PAYMENT ELIGIBILITY AND COMPUTATION access file 3/18/2005
Subchapter 27
reserved
Subchapter 28
Reimbursement
37.86.2801 ALL HOSPITAL REIMBURSEMENT, GENERAL access file 7/1/2014
Rule 37.86.2802 reserved
37.86.2803 ALL HOSPITAL REIMBURSEMENT, COST REPORTING access file 4/26/2013
Rules 37.86.2804 and 37.86.2805 reserved
37.86.2806 COST-BASED HOSPITAL, GENERAL REIMBURSEMENT access file 7/1/2014
Rules 37.86.2807 through 37.86.2809 reserved
37.86.2810 INPATIENT AND OUTPATIENT HOSPITAL SERVICES, QUALIFIED RATE ADJUSTMENT PAYMENT, ELIGIBILITY, AND COMPUTATION REP 7/1/2010
Rules 37.86.2811 through 37.86.2819 reserved
37.86.2820 DESK REVIEWS, OVERPAYMENTS, AND UNDERPAYMENTS access file 7/1/2014
Subchapter 29
Inpatient Hospital Services
37.86.2901 INPATIENT HOSPITAL SERVICES, DEFINITIONS access file 7/1/2014
37.86.2902 INPATIENT HOSPITAL SERVICES, REQUIREMENTS access file 7/1/2014
37.86.2903 INPATIENT HOSPITAL SERVICES, EXCLUSIONS access file 7/1/2010
37.86.2904 INPATIENT HOSPITAL SERVICES, BILLING REQUIREMENTS access file 7/1/2010
37.86.2905 INPATIENT HOSPITAL SERVICES, GENERAL REIMBURSEMENT access file 7/1/2010
Rule 37.86.2906 reserved
37.86.2907 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION access file 3/14/2014
Rules 37.86.2908 and 37.86.2909 reserved
37.86.2910 INPATIENT HOSPITAL REIMBURSEMENT, QUALIFIED RATE ADJUSTMENT PAYMENT REP 7/1/2010
Rule 37.86.2911 reserved
37.86.2912 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, CAPITAL-RELATED COSTS access file 7/1/2010
Rule 37.86.2913 reserved
37.86.2914 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, MEDICAL EDUCATION COSTS REP 10/1/2008
Rule 37.86.2915 reserved
37.86.2916 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, COST OUTLIERS access file 7/1/2010
Rule 37.86.2917 reserved
37.86.2918 INPATIENT HOSPITAL, READMISSIONS, PARTIAL ELIGIBILITY, OUTPATIENT BUNDLING, AND TRANSFERS FOR PROSPECTIVE PAYMENT SYSTEM (PPS) FACILITIES access file 4/1/2012
Rule 37.86.2919 reserved
37.86.2920 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, HOSPITAL RESIDENTS access file 7/1/2010
37.86.2921 HOSPITAL RESIDENCY REQUIREMENTS access file 7/1/2010
Rules 37.86.2922 and 37.86.2923 reserved
37.86.2924 INPATIENT HOSPITAL COST BASED REIMBURSEMENT, CERTIFIED REGISTERED NURSE ANESTHETISTS access file 10/1/2008
37.86.2925 INPATIENT HOSPITAL REIMBURSEMENT, DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS access file 1/1/2014
Rules 37.86.2926 and 37.86.2927 reserved
37.86.2928 INPATIENT HOSPITAL REIMBURSEMENT, HOSPITAL REIMBURSEMENT ADJUSTOR access file 1/1/2014
Rules 37.86.2929 and 37.86.2930 reserved
37.86.2931 ROUTINE AND SUPPLEMENTAL DISPROPORTIONATE SHARE HOSPITAL access file 2/27/2004
37.86.2932 MEDICAID UTILIZATION RATE access file 10/26/2007
Rules 37.86.2933 and 37.86.2934 reserved
37.86.2935 CALCULATING LOW INCOME UTILIZATION RATE, FOR ROUTINE DISPROPORTIONATE SHARE HOSPITALS access file 2/27/2004
Rules 37.86.2936 through 37.86.2939 reserved
37.86.2940 HOSPITAL REIMBURSEMENT ADJUSTOR (HRA), DATA SOURCES access file 2/27/2004
Rules 37.86.2941 and 37.86.2942 reserved
37.86.2943 BORDER HOSPITAL REIMBURSEMENT access file 10/1/2008
Rules 37.86.2944 through 37.86.2946 reserved
37.86.2947 OUT-OF-STATE HOSPITAL AND CENTERS OF EXCELLENCE REIMBURSEMENT access file 7/1/2010
37.86.2950 GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM access file 7/29/2011
Subchapter 30
Outpatient Hospital Services
37.86.3001 OUTPATIENT HOSPITAL SERVICES, DEFINITIONS access file 7/1/2014
37.86.3002 OUTPATIENT HOSPITAL SERVICES, SCOPE AND REQUIREMENTS access file 7/13/2012
37.86.3003 OUTPATIENT HOSPITAL SERVICES, EXCLUSIONS access file 7/13/2012
Rule 37.86.3004 reserved
37.86.3005 OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT access file 7/13/2012
37.86.3006 MENTAL HEALTH OUTPATIENT PARTIAL HOSPITAL SERVICES, REQUIREMENTS access file 7/13/2012
37.86.3007 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, CLINICAL DIAGNOSTIC LABORATORY SERVICES access file 1/1/2007
Rule 37.86.3008 reserved
37.86.3009 OUTPATIENT HOSPITAL SERVICES, PAYMENT METHODOLOGY, EMERGENCY VISIT SERVICES access file 7/1/2014
Rule 37.86.3010 reserved
37.86.3011 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, NONEMERGENT EMERGENCY ROOM SERVICES REP 8/1/2003
Rules 37.86.3012 and 37.86.3013 reserved
37.86.3014 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, DIALYSIS SERVICES REP 7/13/2012
Rule 37.86.3015 reserved
37.86.3016 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, IMAGING SERVICES access file 7/13/2012
Rule 37.86.3017 reserved
37.86.3018 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, OTHER DIAGNOSTIC SERVICES access file 7/13/2012
Rule 37.86.3019 reserved
37.86.3020 OUTPATIENT HOSPITAL SERVICES, OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (OPPS) METHODOLOGY, AMBULATORY PAYMENT CLASSIFICATION access file 7/1/2014
Rule 37.86.3021 reserved
37.86.3022 OUTPATIENT HOSPITAL SERVICES, PARTIAL HOSPITALIZATION SERVICES access file 3/24/2006
Rules 37.86.3023 and 37.86.3024 reserved
37.86.3025 OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT FOR SERVICES NOT PAID UNDER THE AMBULATORY PAYMENT CLASSIFICATION SYSTEM access file 7/13/2012
Rules 37.86.3026 through 37.86.3030 reserved
37.86.3031 PROVIDER BASED ENTITY SERVICES, GENERAL access file 7/13/2012
Rule 37.86.3032 reserved
37.86.3033 PROVIDER-BASED ENTITY SERVICES, RECIPIENT ACCESS AND NOTIFICATION access file 7/13/2012
Rule 37.86.3034 reserved
37.86.3035 PROVIDER BASED ENTITY SERVICES, COMPLIANCE, AND PENALTIES access file 1/1/2007
Rule 37.86.3036 reserved
37.86.3037 PROVIDER-BASED ENTITY SERVICES, REIMBURSEMENT access file 7/13/2012
Subchapter 31
Outpatient Hospital Rehabilitation and Therapy Services
37.86.3101 OUTPATIENT HOSPITAL SERVICES, CARDIAC AND PULMONARY REHABILITATION SERVICES access file 7/1/2014
Rule 37.86.3102 reserved
37.86.3103 OUTPATIENT HOSPITAL SERVICES, CARDIAC REHABILITATION SERVICES access file 7/1/2014
Rule 37.86.3104 reserved
37.86.3105 OUTPATIENT HOSPITAL SERVICES, PULMONARY REHABILITATION SERVICES access file 7/1/2014
Rule 37.86.3106 reserved
37.86.3107 OUTPATIENT HOSPITAL SERVICES, CARDIAC AND PULMONARY REHABILITATION, WAIVER OF SERVICE LIMITATIONS access file 6/23/2006
Rule 37.86.3108 reserved
37.86.3109 OUTPATIENT CARDIAC AND PULMONARY REHABILITATION REIMBURSEMENT access file 7/13/2012
Subchapter 32
Nonhospital Laboratory and Radiology (X-Ray) Services
37.86.3201 NONHOSPITAL LABORATORY AND RADIOLOGY (X-RAY) SERVICES, REQUIREMENTS access file 1/1/2013
Rules 37.86.3202 through 37.86.3204 reserved
37.86.3205 NONHOSPITAL LABORATORY AND RADIOLOGY (X-RAY) SERVICES, REIMBURSEMENT access file 7/1/2014
Subchapter 33
Case Management Services - General
37.86.3301 CASE MANAGEMENT SERVICES, GENERAL DEFINITIONS access file 3/11/1997
Rules 37.86.3302 through 37.86.3304 reserved
37.86.3305 CASE MANAGEMENT SERVICES, GENERAL PROVISIONS access file 3/11/1997
37.86.3306 CASE MANAGEMENT SERVICES, GENERAL ELIGIBILITY access file 7/1/1999
Subchapter 34
Case Management Services for High Risk Pregnant Women
37.86.3401 CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, DEFINITIONS access file 3/11/1997
37.86.3402 CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, ELIGIBILITY access file 3/11/1997
Rules 37.86.3403 and 37.86.3404 reserved
37.86.3405 CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, COVERAGE access file 7/26/1991
Rules 37.86.3406 through 37.86.3409 reserved
37.86.3410 CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, PROVIDER REQUIREMENTS access file 3/11/1997
37.86.3411 CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, FINANCIAL RECORDS, AND REPORTING access file 2/27/2004
Rules 37.86.3412 through 37.86.3414 reserved
37.86.3415 CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, REIMBURSEMENT access file 6/7/1996
Subchapter 35
Case Management Services for Adults with Severe Disabling Mental Illness
37.86.3501 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, DEFINITIONS access file 2/12/2010
37.86.3502 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, ELIGIBILITY access file 1/1/2004
37.86.3503 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, SEVERE DISABLING MENTAL ILLNESS access file 2/12/2010
Rule 37.86.3504 reserved
37.86.3505 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, SERVICE COVERAGE access file 2/12/2010
37.86.3506 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, SERVICE REQUIREMENTS access file 2/12/2010
37.86.3507 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, PROVIDER REQUIREMENTS access file 5/23/2003
Rules 37.86.3508 through 37.86.3514 reserved
37.86.3515 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, REIMBURSEMENT access file 7/1/2013
Subchapter 36
Case Management Services for Persons Age 16 and Over with Developmental Disabilities
37.86.3601 CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, DEFINITIONS access file 3/11/1997
37.86.3602 CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, ELIGIBILITY access file 3/11/1997
Rules 37.86.3603 and 37.86.3604 reserved
37.86.3605 CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, COVERAGE access file 3/11/1997
37.86.3606 CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, PROVIDER REQUIREMENTS access file 3/11/1997
37.86.3607 CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, REIMBURSEMENT access file 7/1/2014
Subchapter 37
Case Management Services for Youth with Serious Emotional Disturbance
37.86.3701 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, DEFINITIONS REP 2/27/2009
37.86.3702 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY REP 2/27/2009
Rules 37.86.3703 and 37.86.3704 reserved
37.86.3705 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, SERVICE COVERAGE REP 2/27/2009
37.86.3706 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, SERVICE REQUIREMENTS REP 2/27/2009
37.86.3707 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, PROVIDER REQUIREMENTS REP 2/27/2009
Rules 37.86.3708 through 37.86.3714 reserved
37.86.3715 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, REIMBURSEMENT REP 2/27/2009
Subchapter 38
Case Management Services for Children at Risk of Abuse and Neglect
37.86.3801 CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, DEFINITIONS access file 3/11/1997
Rules 37.86.3802 through 37.86.3804 reserved
37.86.3805 CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, COVERAGE access file 3/11/1997
37.86.3806 MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, ELIGIBILITY access file 6/18/2004
Rules 37.86.3807 through 37.86.3809 reserved
37.86.3810 MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, PROVIDER REQUIREMENTS access file 6/18/2004
37.86.3811 MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, REIMBURSEMENT access file 6/18/2004
Subchapter 39
Case Management Services for Children with Special Health Care Needs
37.86.3901 CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, DEFINITIONS access file 3/11/1997
37.86.3902 CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, ELIGIBILITY access file 3/11/1997
Rules 37.86.3903 and 37.86.3904 reserved
37.86.3905 CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, COVERAGE access file 3/11/1997
37.86.3906 CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, PROVIDER REQUIREMENTS access file 3/11/1997
Rules 37.86.3907 through 37.86.3909 reserved
37.86.3910 CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, REIMBURSEMENT access file 3/11/1997
Subchapter 40
Targeted Case Management Services for Substance Use Disorders
37.86.4001 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, DEFINITIONS access file 3/1/2013
37.86.4002 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, ELIGIBILITY access file 3/1/2013
37.86.4005 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, SERVICE COVERAGE access file 3/1/2013
37.86.4006 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, SERVICE REQUIREMENTS access file 3/1/2013
37.86.4007 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, PROVIDER REQUIREMENTS access file 3/1/2013
37.86.4010 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, REIMBURSEMENT access file 7/1/2013
Subchapter 41
reserved
Subchapter 42
Dialysis Clinics for End Stage Renal Disease
37.86.4201 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, DEFINITIONS access file 10/28/2011
37.86.4202 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REQUIREMENTS access file 7/1/2014
Rules 37.86.4203 and 37.86.4204 reserved
37.86.4205 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REIMBURSEMENT access file 7/1/2014
Subchapter 43
reserved
Subchapter 44
Rural Health Clinics and Federally Qualified Health Centers
37.86.4401 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, DEFINITIONS access file 6/17/2005
37.86.4402 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, VISITS AND ENCOUNTERS access file 6/17/2005
Rules 37.86.4403 and 37.86.4404 reserved
37.86.4405 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, PROVIDER PARTICIPATION REQUIREMENTS access file 10/12/2001
37.86.4406 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, SERVICE REQUIREMENTS access file 10/26/2007
37.86.4407 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, RECORD KEEPING AND REPORTS access file 6/17/2005
Rules 37.86.4408 through 37.86.4411 reserved
37.86.4412 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, REIMBURSEMENT access file 6/17/2005
37.86.4413 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, ESTABLISHMENT OF INITIAL PAYMENT FOR NEW CLINICS OR CENTERS access file 6/17/2005
37.86.4414 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, SUPPLEMENTAL PAYMENTS IN CASE OF MANAGED CARE access file 10/12/2001
Rules 37.86.4415 through 37.86.4419 reserved
37.86.4420 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, ALTERNATIVE PAYMENT METHODOLOGIES access file 10/12/2001
Subchapter 45
reserved
Subchapter 46
reserved
Subchapter 47
Organ Transplant Services
37.86.4701 ORGAN TRANSPLANTATION, DEFINITIONS access file 10/16/2009
Rules 37.86.4702 through 37.86.4704 reserved
37.86.4705 ORGAN TRANSPLANTATION, REQUIREMENTS access file 10/16/2009
37.86.4706 ORGAN TRANSPLANTATION, REIMBURSEMENT access file 10/16/2009
Subchapter 48
reserved
Subchapter 49
reserved
Subchapter 50
Health Maintenance Organizations (HMO)
37.86.5001 HEALTH MAINTENANCE ORGANIZATIONS: DEFINITIONS access file 3/31/2000
37.86.5002 HEALTH MAINTENANCE ORGANIZATIONS: RECIPIENT ELIGIBILITY access file 3/31/2000
Rules 37.86.5003 and 37.86.5004 reserved
37.86.5005 HEALTH MAINTENANCE ORGANIZATIONS: ENROLLMENT access file 3/31/2000
37.86.5006 HEALTH MAINTENANCE ORGANIZATIONS: DISENROLLMENT access file 3/31/2000
37.86.5007 HEALTH MAINTENANCE ORGANIZATIONS: COVERED SERVICES access file 3/31/2000
Rules 37.86.5008 and 37.86.5009 reserved
37.86.5010 HEALTH MAINTENANCE ORGANIZATIONS: CONTRACTS FOR SERVICES access file 3/31/2000
37.86.5011 HEALTH MAINTENANCE ORGANIZATIONS: PROVISION OF SERVICES access file 3/31/2000
37.86.5012 HEALTH MAINTENANCE ORGANIZATIONS: PARTICIPATING PROVIDERS access file 6/30/2000
37.86.5013 HEALTH MAINTENANCE ORGANIZATIONS: REIMBURSEMENT OF PROVIDERS access file 7/8/1997
37.86.5014 HEALTH MAINTENANCE ORGANIZATIONS: REIMBURSEMENT OF HMOS access file 3/31/2000
Rules 37.86.5015 through 37.86.5019 reserved
37.86.5020 HEALTH MAINTENANCE ORGANIZATIONS: ACCESS TO SERVICES access file 3/31/2000
Rules 37.86.5021 through 37.86.5024 reserved
37.86.5025 HEALTH MAINTENANCE ORGANIZATIONS: GRIEVANCE PROCEDURES access file 6/30/2000
37.86.5026 HEALTH MAINTENANCE ORGANIZATIONS: RECORDS AND CONFIDENTIALITY access file 3/31/2000
37.86.5027 HEALTH MAINTENANCE ORGANIZATIONS: RECIPIENT EDUCATION access file 7/8/1997
Rules 37.86.5028 through 37.86.5034 reserved
37.86.5035 HEALTH MAINTENANCE ORGANIZATIONS: QUALITY ASSURANCE access file 3/31/2000
37.86.5036 HEALTH MAINTENANCE ORGANIZATIONS: THIRD PARTY access file 9/29/1995
Subchapter 51
Passport to Health Program
37.86.5101 PASSPORT TO HEALTH PROGRAM: AUTHORITY access file 8/9/2013
37.86.5102 PASSPORT TO HEALTH PROGRAM: DEFINITIONS access file 8/9/2013
37.86.5103 PASSPORT TO HEALTH PROGRAM: ELIGIBILITY access file 8/9/2013
37.86.5104 PASSPORT TO HEALTH PROGRAM: ENROLLMENT IN THE PROGRAM access file 8/9/2013
Rules 37.86.5105 through 37.86.5109 reserved
37.86.5110 PASSPORT TO HEALTH PROGRAM: SERVICES access file 8/9/2013
37.86.5111 PASSPORT TO HEALTH PROGRAM: PRIMARY CARE PROVIDERS REQUIREMENTS access file 1/17/2014
37.86.5112 PASSPORT TO HEALTH PROGRAM: REIMBURSEMENT access file 8/9/2013
Rules 37.86.5113 through 37.86.5119 reserved
37.86.5120 PASSPORT TO HEALTH PROGRAM: FAIR HEARING access file 6/30/2000
Subchapter 52
Health Improvement Program
37.86.5201 HEALTH IMPROVEMENT PROGRAM: DEFINITIONS access file 6/25/2010
37.86.5202 HEALTH IMPROVEMENT PROGRAM: GENERAL access file 6/25/2010
Rule 37.86.5203 reserved
37.86.5204 CRITERIA FOR DETERMINING MEDICAID AND HEALTHY MONTANA KIDS PLUS (HMK PLUS) ELIGIBLE INDIVIDUALS MANAGED UNDER THE HEALTH IMPROVEMENT PROGRAM access file 6/25/2010
37.86.5205 HEALTH IMPROVEMENT PROGRAM: CLIENT ELIGIBILITY AND ASSIGNMENT access file 6/25/2010
37.86.5206 HEALTH IMPROVEMENT PROGRAM: SCOPE OF SERVICES AND REIMBURSEMENT access file 6/25/2010
Subchapter 53
Passport to Health Team Care Program
Rules 37.86.5301 and 37.86.5302 reserved
37.86.5303 PASSPORT TO HEALTH'S TEAM CARE PROGRAM access file 7/23/2004
Rules 37.86.5304 and 37.86.5305 reserved
37.86.5306 TEAM CARE PROGRAM: REIMBURSEMENT access file 7/23/2004
Subchapter 54
Preventive Services
37.86.5401 PURPOSE access file 8/24/2012
37.86.5402 DEFINITIONS access file 8/24/2012
37.86.5403 DIABETES AND CARDIOVASCULAR DISEASE PREVENTION SERVICES GENERAL access file 8/24/2012
37.86.5404 DIABETES AND CARDIOVASCULAR DISEASE PREVENTION SERVICES REIMBURSEMENT access file 8/24/2012
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