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(1) The requirements of ARM 37.86.2801, 37.86.2803, 37.86.3001, 37.86.3005 and this rule are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Outpatient hospital services are services that would also be covered by Medicaid if provided in a nonhospital setting and are limited to the following diagnostic and therapeutic services furnished by hospitals to outpatients:

(a) diagnostic services, including:

(i) the services of nurses, psychologists and technicians;

(ii) drugs and biologicals;

(iii) laboratory and imaging services;

(iv) psychological tests;

(v) supplies and equipment; and

(vi) other tests to determine the nature and severity of a medical condition;

(b) therapeutic services and supplies, including:

(i) emergency room services;

(ii) clinic services; and

(iii) the use of hospital facilities incident to provision of physician services to the patient where the services and supplies are furnished in the hospital on a physician's order by hospital personnel under the supervision of hospital medical staff;

(c) chemical dependency treatment services;

(d) services provided outside the hospital, as follows:

(i) diagnostic services provided by hospital personnel outside the hospital premises with or without direct personal supervision of a physician;

(ii) therapeutic services that are incidental to physician services and provided under the direct personal supervision of a physician. Outpatient physical therapy, occupational therapy, and speech therapy are not subject to the direct physician supervision requirement. Therapy services are limited as in ARM 37.86.606;

(e) diabetes education services provided by a hospital whose diabetes education programs are in compliance with ARM 37.86.5401 through 37.86.5404; and

(f) lactation services performed by nonphysician providers, i.e., certified lactation providers. These services will only be allowed to be billed by the facility effective January 1, 2016.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1983 MAR p. 756, Eff. 7/1/83; AMD, 1993 MAR p. 2819, Eff. 11/1/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1996 MAR p. 1682, Eff. 6/21/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1209, Eff. 7/8/97; AMD, 1997 MAR p. 1269, Eff. 7/22/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2015 MAR p. 2289, Eff. 12/25/15.

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