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(1) A member must obtain services directly from, or through, a Passport referral by the member's primary care provider except for:

(a) obstetrical services, both inpatient and outpatient;

(b) family planning services as defined in Social Security Act 1905(a)(4)(c) and ARM 37.86.1701;

(c) anesthesiology services;

(d) pathology services;

(e) ophthalmology services for medical conditions of the eye;

(f) immunization;

(g) testing and treatment for sexually transmitted diseases as defined in ARM 37.114.101;

(h) testing for lead blood levels;

(i) dental, vision, hearing, and EPSDT screening and preventive services;

(j) school-based health services as defined in ARM 37.86.2230;

(k) swing-bed hospital services as defined in ARM 37.40.401;

(l) audiology services as defined in ARM 37.86.702;

(m) hearing aid services as defined in ARM 37.86.801;

(n) personal care services as defined in ARM 37.40.1101;

(o) home dialysis services for end-stage renal disease as defined in ARM 37.40.901;

(p) home infusion therapy services as defined in ARM 37.86.1501;

(q) mental health center services as provided in ARM 37.88.901 and 37.88.905 through 37.88.907;

(r) licensed psychologists services provided in ARM 37.88.601, 37.88.605, and 37.88.606;

(s) substance use disorder services as provided in ARM 37.27.102;

(t) licensed clinical social work services provided in ARM 37.88.201, 37.88.205, and 37.88.206;

(u) dental services as defined in ARM 37.86.1001;

(v) licensed professional counselor services provided in ARM 37.88.301, 37.88.305, and 37.88.306;

(w) outpatient drugs as defined in ARM 37.86.1101;

(x) prosthetic devices, durable medical equipment, and medical supplies as defined in ARM 37.86.1801;

(y) optometric services as defined in ARM 37.86.2001;

(z) eyeglasses as defined in ARM 37.86.2101;

(aa) transportation and per diem as defined in ARM 37.86.2401;

(ab) specialized nonemergency medical transportation as defined in ARM 37.86.2501;

(ac) ambulance services as defined in ARM 37.86.2601;

(ad) emergency services as defined in ARM 37.82.102;

(ae) skilled care facility services as defined in ARM 37.40.105;

(af) intermediate care facility services as defined in ARM 37.40.106;

(ag) institution for mental disease services as provided in ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411, and 37.88.1420;

(ah) home and community-based services as defined in ARM 37.40.1406;

(ai) freestanding dialysis clinic for end-stage renal disease services as defined in ARM 37.86.4201;

(aj) case management services as defined in ARM 37.86.3301;

(ak) hospital inpatient laboratory and radiology (x-ray);

(al) admission for inpatient psychiatric services as provided in ARM 37.86.2901, 37.86.2902, 37.87.1201, and 37.87.1203;

(am) therapeutic youth group home or home support and therapeutic foster care services under the EPSDT program;

(an) hospice as defined in ARM 37.40.801 and 37.40.806; and

(ao) professional inpatient services.

(2) The requirement that specific services not listed in (1) be referred by the primary care provider does not replace or eliminate other regulatory or statutory requirements for or limits on obtaining and being reimbursed for Medicaid services.

(3) Nothing in this rule reduces or otherwise affects the requirements that must be met under ARM 37.88.101, to obtain or access adult mental health services as provided in this chapter.

History: 53-2-201, 53-6-101, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-116, MCA; NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1994 MAR p. 2983, Eff. 11/11/94; AMD, 1996 MAR p. 2193, Eff. 8/9/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1997 MAR p. 2085, Eff. 11/18/97; AMD, 1998 MAR p. 2045, Eff. 7/31/98; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1338, Eff. 3/31/00; AMD, 2003 MAR p. 1203, Eff. 6/13/03; AMD, 2008 MAR p. 2673, Eff. 12/25/08; AMD, 2013 MAR p. 1447, Eff. 8/9/13; AMD, 2015 MAR p. 1912, Eff. 10/30/15.

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