(1) These requirements are in addition to those requirements contained in ARM 37.85.401 through 37.85.414.

(2) Clinic services must be provided by a clinic which is licensed as an outpatient facility by the appropriate licensing entity of the state where the facility is located and meet the requirement for participation in Medicare.

(3) Clinic services must be provided by, or under the direction of a licensed physician or, where appropriate a licensed dentist.

(4) Patients receiving ambulatory surgical center services must be either class I anesthesia risk or a class II anesthesia risk.

(5) Conditions for coverage of listed ambulatory surgical center procedures:

(a) Covered surgical procedures are limited to those procedures that do not generally exceed:

(i) a total of 90 minutes operating time; and

(ii) a total of four hours recovery or convalescent time.

(b) If the covered surgical procedure requires anesthesia, the anesthesia must be:

(i) local or regional anesthesia; or

(ii) general anesthesia of 90 minutes or less duration.

(c) Covered surgical procedures may not be of a type that:

(i) generally result in extensive blood loss;

(ii) requires a major or prolonged invasion of body cavities;

(iii) directly involves major blood vessels;

(iv) are generally emergency or life threatening in nature; or

(v) can safely be performed in a physician's or dentist's office.

(d) Covered surgical procedures can only be rendered by a licensed ambulatory surgical center.

(6) Public health department services consist of the following types of services:

(a) Mid-level practitioner services which:

(i) are provided through a public health department; and

(ii) meet all requirements specified in ARM 37.86.201, 37.86.202, and 46.12.2012.

(b) Physician services which:

(i) are provided either:

(A) directly by the physician; or

(B) by a public health nurse under a physician's immediate supervision. This means the physician has seen the patient and ordered the services except that a minimal service does not require the physician to see the patient. Minimal services are covered when provided by a licensed registered nurse under protocols provided by a physician affiliated with the public health department. Protocols shall be updated at least annually.

(ii) meet the requirements specified in ARM 37.86.105.

(7) Telephone contacts are not a clinic service.