(1) Except as otherwise provided in this rule, the following medical or remedial care and services shall be available to all persons who are certified eligible for Medicaid benefits under this chapter (including deceased persons, categorically related, who would have been eligible had death not prevented them from applying) . However, only those medical or remedial care and services also covered by Medicare shall be available to a person who is certified eligible for Medicaid benefits as a qualified Medicare beneficiary under ARM 37.83.201 and 37.83.202.

(a) inpatient hospital services;

(b) outpatient hospital services;

(c) non-hospital laboratory and x-ray services;

(d) nursing facility services;

(e) early and periodic screening, diagnosis and treatment services;

(f) physician's services;

(g) podiatry services;

(h) outpatient physical therapy services;

(i) speech therapy, audiology and hearing aid services;

(j) outpatient occupational therapy services;

(k) home health care services;

(l) personal care services in a recipient's home;

(m) home dialysis services;

(n) private duty nursing services;

(o) clinic services;

(p) dental services;

(q) outpatient drugs;

(r) durable medical equipment, prosthetic devices and medical supplies;

(s) eyeglasses and optometric services;

(t) transportation and per diem;

(u) ambulance services;

(v) specialized nonemergency transportation;

(w) family planning services;

(x) home and community services;

(y) mid-level practitioner services;

(z) hospice services;

(aa) licensed psychologist services;

(ab) licensed clinical social worker services;

(ac) licensed professional counselor services;

(ad) inpatient psychiatric services;

(ae) mental health center services;

(af) case management services;

(ag) institutions for mental diseases for persons age 65 and over; and

(ah) payment of premiums, co-insurance, deductibles and other cost sharing obligations under an individual or group health plan in accordance with the provisions of ARM 37.82.424.

(2) Individuals who are recipients of assistance in the pathways, community services or job supplement components of the Families Achieving Independence in Montana (FAIM) project and who are 21 years of age or older and all recipients of AFDC-related medical assistance only who are participating in the FAIM project and are 21 years of age or older will receive basic Medicaid benefits, except that pregnant women will be entitled to all services specified in (1) (a) through (1) (ah) of this rule. Basic Medicaid benefits are the services specified in (1) (a) through (1) (ah) of this rule except the following:

(a) eyeglasses and routine eye exams, whether provided by an optometrist, ophthalmologist or other provider;

(b) audiology and hearing aids;

(c) personal care services in the recipient's home;

(d) dental services; and

(e) durable medical equipment and supplies.

(3) With regard to persons identified in (2) who receive basic Medicaid benefits, the department will provide the noncovered services specified in (2) (a) through (2) (e) :

(a) if the noncovered services are required as a condition of employment; or

(b) on an emergency basis. For purposes of this rule, an emergency is a situation which:

(i) arises suddenly or unexpectedly; and

(ii) is life-threatening or has very serious implications for the individual's health.