Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.50 - Health Maintenance Organizations (HMO) › Rule 37.86.5007 - HEALTH MAINTENANCE ORGANIZATIONS: COVERED SERVICES

Current through Register Vol. 13, July 5, 2024
(1) An HMO must provide the following
				services:
(a) inpatient hospital services as
				defined at ARM
				37.86.2901 and
				37.86.2902;
(b) outpatient hospital services as defined
				at ARM 37.86.3001 and
				37.86.3002;
(c) physician services as defined at ARM
				37.86.101 and
				37.86.104;
(d) family planning services as defined at
				ARM 37.86.1701 and
				37.86.1705;
(e) home health services as defined at ARM
				37.40.701 and
				37.40.702;
(f) early periodic screening, diagnosis and
				treatment services for individuals under the age of 21 (EPSDT) as defined at
				ARM 37.86.1401,
				37.86.1402,
				37.86.2201,
				37.86.2205 and
				37.86.2206;
(g) non-hospital laboratory and x-ray
				services as defined at ARM 37.86.911;
(h) rural health clinic services as defined
				at ARM 37.86.4001;
(i) ambulance services as defined at ARM
				37.86.2601 and
				37.86.2602;
(j) ambulatory surgical center services as
				defined at ARM 37.86.1401, 37.86.1402 and 37.86.1405 ;
(k) chiropractor services as defined at ARM
				37.86.2206(2)
				(b);
(l) diagnostic clinic services as defined at
				ARM 37.86.1401 and
				37.86.1402;
(m) nutrition services
				as defined at ARM
				37.86.2206(2)
				(a);
(n) federally qualified health center
				services as defined at ARM
				37.86.4401;
(o) hospice services as defined at ARM
				37.40.801 and
				37.40.806;
(p) mid-level practitioner services as
				defined at ARM
				37.86.201 and
				37.86.202;
(q) immunizations recommended by the advisory
				committee on immunization practices;
(r) occupational therapy services as defined
				at ARM 37.86.601;
(s) physical therapy services as defined at
				ARM 37.86.601;
(t) podiatry
				services as defined at ARM
				37.86.501 and
				37.86.505;
(u) private duty nursing services as defined
				at ARM 37.86.2206(2)
				(f);
(v) county public health clinic services as
				defined at ARM
				37.86.1401 and
				37.86.1402;
(w) respiratory therapy
				services as defined at ARM
				37.86.2206(2)
				(d);
(x) immunizations and well child screens
				provided by school based providers;
(y) speech therapy services as defined at ARM
				37.86.601;
(z) targeted case
				management services for high risk pregnant women as defined at ARM
				37.86.3301,
				37.86.3305,
				37.86.3006,
				37.86.3401,
				37.86.3402 and
				37.86.3405; and
(aa) transplant services as defined at ARM
				37.86.4701 and
				37.86.4705.
(ab) prescription drugs supplied by a
				participating provider or a provider with a family planning and/or public
				health clinic;
(ac) durable medical
				equipment limited to diabetic supplies, oxygen, prosthetics, ostomy or
				incontinence supplies and only if supplied by a participating provider or a
				provider with a family planning and/or public health clinic;
(ad) optometric/ophthalmic services for
				medical conditions of the eye.