(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.