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37.85.206    SERVICES PROVIDED

(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; and

(ai) diabetes and cardiovascular disease prevention services.

(2) Individuals who will receive basic Medicaid benefits are:

(a) qualified for:

(i) family or family-transitional Medicaid services; or

(ii) MHSP waiver services.

(b) age 21 through 64;

(c) not pregnant; and

(d) not disabled (according to Social Security Administration (SSA) criteria).

(3) 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.

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

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-103, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA; NEW, 1980 MAR p. 1789, Eff. 6/27/80; AMD, 1986 MAR p. 677, Eff. 4/25/86; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1988 MAR p. 2228, Eff. 10/14/88; AMD, 1989 MAR p. 835, Eff. 6/30/89; AMD, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1991 MAR p. 1021, Eff. 6/28/91; AMD, 1992 MAR p. 1401, Eff. 6/26/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1996 MAR p. 284, Eff. 1/26/96; AMD, 1997 MAR p. 474, Eff. 3/11/97; AMD, 1997 MAR p. 898, Eff. 3/25/97; AMD, 1999 MAR p. 1806, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479; AMD, 2009 MAR p. 2379, Eff. 1/1/10; AMD, 2012 MAR p. 1671, Eff. 8/24/12.

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