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37.86.1401    CLINIC SERVICES, DEFINITIONS

(1) "Clinic services" means preventive diagnostic, therapeutic, rehabilitative, or palliative items or services provided under the direction of a physician by an outpatient facility that is not part of a hospital, but is organized and operated to provide medical care to outpatients independent of a hospital. Clinic services may be provided in surgical centers and public health departments. Clinic services do not include mental health center services as defined in ARM 37.88.901.

(2) "Ambulatory surgical center services" means clinic services which are provided in a licensed, freestanding ambulatory surgical center, but do not include physicians services, anesthesiologists services, ambulance services, or major prosthetic appliances such as intraocular lenses.

(3) "Class I anesthesia risk" means an individual with no detectable systemic diseases and no physical abnormalities which would in any way impair the functioning of his jaw, neck, airway, chest, or abdominal function.

(4) "Class II anesthesia risk" means an individual who has only one systemic disease which can potentially threaten the safe outcome of an anesthesia.

(5) "Public health department services" mean physician services and mid-level practitioner services as provided for in 50-2-116, 50-2-118, and 50-2-119, MCA.

(6) "Protocols" mean written plans developed by a public health clinic in collaboration with physician and nursing staff specifying the nursing procedures to be followed in giving a specific exam, or providing care for particular conditions. Protocols must be updated and approved by a physician at least annually.

(7) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois adopted at ARM 37.86.101 sets forth meanings of terms commonly used by the Montana Medicaid program in implementation of the program's public health clinic fee schedule.

(8) The "Physician-Related Services Manual" means the physician-related services manual adopted at ARM 37.86.101. It governs the administration of the Public Health Clinic program.

 

History: 53-2-201, 53-6-113, MCA; IMP, 53-6-101, 53-6-141, MCA; NEW, Eff. 11/4/74; AMD, 1982 MAR p. 1695, Eff. 9/17/82; AMD, 1989 MAR p. 877, Eff. 6/30/89; AMD, 1989 MAR p. 1850, Eff. 11/10/89; AMD, 1992 MAR p. 1404, Eff. 7/1/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2012 MAR p. 2625, Eff. 1/1/13.

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