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37.86.2902    INPATIENT HOSPITAL SERVICES, REQUIREMENTS

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Except as otherwise permitted by federal law, inpatient hospital services must be ordered by a physician or dentist licensed under state law.

(3) Inpatient hospital services include:

(a) bed and board;

(b) nursing services and other related services;

(c) use of hospital facilities;

(d) medical social services;

(e) drugs, biologicals, supplies, appliances, and equipment;

(f) other diagnostic or therapeutic items, or services provided in the hospital and not specifically excluded in ARM 37.85.207;

(g) medical or surgical services provided by interns or residents-in-training in hospitals with teaching programs approved by the Council on Medical Education of the American Medical Association, the Bureau of Professional Education of the American Osteopathic Association, the Council on Dental Education of the American Dental Association or the Council on Podiatry Education of the American Podiatry Association.

(4) Alcohol and drug treatment services are limited to:

(a) detoxification services up to four days, except that more than four days may be covered if concurrently authorized by the designated review organization and a hospital setting is required; or

(b) the designated review organization determines that the patient has a concomitant condition that must be treated in the inpatient hospital setting, and the alcohol and drug treatment is a necessary adjunct to the treatment of the concomitant condition.

(5) Inpatient hospital services provided outside the borders of the United States will not be reimbursed by the Montana Medicaid program.

History: 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA; NEW, 1983 MAR p. 756, Eff. 7/1/83; AMD, 1987 MAR p. 905, Eff. 7/1/87; AMD, 1987 MAR p. 2168, Eff. 11/28/87; AMD, 1989 MAR p. 281, Eff. 2/10/89; AMD, 1993 MAR p. 1520, Eff. 7/16/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1999 MAR p. 2078, Eff. 9/24/99; TRANS, from SRS, 2000 MAR p. 481.

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