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Rule Title: OUTPATIENT HOSPITAL SERVICES, EXCLUSIONS
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Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: MEDICAID PRIMARY CARE SERVICES
Subchapter: Outpatient Hospital Services
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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37.86.3003    OUTPATIENT HOSPITAL SERVICES, EXCLUSIONS

(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.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, MCA; NEW, 2006 MAR p. 1640, Eff. 7/1/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2015 MAR p. 2289, Eff. 12/25/15.


 

 
MAR Notices Effective From Effective To History Notes
37-725 12/25/2015 Current History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, MCA; NEW, 2006 MAR p. 1640, Eff. 7/1/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2015 MAR p. 2289, Eff. 12/25/15.
37-585 7/13/2012 12/25/2015 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, MCA; NEW, 2006 MAR p. 1640, Eff. 7/1/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12.
7/1/2006 7/13/2012 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, MCA; NEW, 2006 MAR p. 1640, Eff. 7/1/06.
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