Rule Chapter: 37.86
	Chapter Title: MEDICAID PRIMARY CARE SERVICES

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	37.86 : MEDICAID PRIMARY CARE SERVICES

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Rule No. Rule Title Latest Version Effective Date Subchapter 1 Physician Services 37.86.101 PHYSICIAN SERVICES, DEFINITIONS 9/9/2017 Rules 37.86.102 and 37.86.103 reserved 37.86.104 PHYSICIAN SERVICES, REQUIREMENTS 5/1/2023 37.86.105 PHYSICIAN SERVICES, REIMBURSEMENT/GENERAL REQUIREMENTS AND MODIFIERS 3/1/2018 Rules 37.86.106 and 37.86.107 reserved 37.86.108 MENTAL HEALTH SERVICES PLAN, APPLICATION FORMS, INCOME VERIFICATION 1/12/2001 Rule 37.86.109 reserved 37.86.110 MENTAL HEALTH SERVICES PLAN, ELIGIBILITY REDETERMINATIONS, MEMBERS REQUIRED TO NOTIFY DEPARTMENT OF CHANGES, REPAYMENT OF BENEFITS 1/12/2001 Rule 37.86.111 reserved 37.86.112 MENTAL HEALTH SERVICES PLAN, EMERGENCY MENTAL HEALTH SERVICES, LIABILITY FOR FAILURE TO COMPLETE APPLICATION 1/12/2001 Subchapter 2 Mid-level Practitioner Services 37.86.201 MID-LEVEL PRACTITIONER SERVICES, REQUIREMENTS 2/11/1994 37.86.202 MID-LEVEL PRACTITIONER SERVICES, DEFINITIONS 2/13/2015 Rules 37.86.203 and 37.86.204 reserved 37.86.205 MID-LEVEL PRACTITIONER SERVICES, REQUIREMENTS AND REIMBURSEMENT 3/1/2018 Subchapter 5 Podiatry Services 37.86.501 PODIATRY SERVICES, DEFINITIONS 1/1/2013 Rules 37.86.502 through 37.86.504 reserved 37.86.505 PODIATRY SERVICES, REQUIREMENTS 3/31/2000 37.86.506 PODIATRY SERVICES, REIMBURSEMENT 3/1/2018 Subchapter 6 Therapy Services 37.86.601 THERAPY SERVICES, DEFINITIONS 5/7/2016 Rules 37.86.602 through 37.86.604 reserved 37.86.605 THERAPY SERVICES, PROVIDER REQUIREMENTS 3/13/1998 37.86.606 THERAPY SERVICES, SERVICE REQUIREMENTS AND RESTRICTIONS 5/7/2016 Rules 37.86.607 through 37.86.609 reserved 37.86.610 THERAPIES, REIMBURSEMENT 1/1/2018 Subchapter 7 Audiology Services 37.86.701 AUDIOLOGY SERVICES, PROVIDER REQUIREMENTS 6/21/1996 37.86.702 AUDIOLOGY SERVICES, SERVICE REQUIREMENTS, AND RESTRICTIONS 10/28/2011 Rules 37.86.703 and 37.86.704 reserved 37.86.705 AUDIOLOGY SERVICES, REIMBURSEMENT 10/20/2018 Subchapter 8 Hearing Aid Services 37.86.801 HEARING AID SERVICES, DEFINITIONS 10/28/2011 37.86.802 HEARING AID SERVICES, REQUIREMENTS, AND LIMITATIONS 10/28/2011 Rules 37.86.803 and 37.86.804 reserved 37.86.805 HEARING AID SERVICES, REIMBURSEMENT 10/20/2018 Subchapter 9 Collaborative Practice Drug Therapy Management 37.86.901 COLLABORATIVE PRACTICE DRUG THERAPY MANAGEMENT - DEFINITIONS 7/1/2017 37.86.902 COLLABORATIVE PRACTICE DRUG THERAPY MANAGEMENT - REQUIREMENTS AND ELIGIBILITY 7/1/2017 37.86.905 COLLABORATIVE PRACTICE DRUG THERAPY MANAGEMENT - REIMBURSEMENT 7/1/2017 Subchapter 10 Dental Services 37.86.1001 DENTAL SERVICES, DEFINITIONS 7/1/2009 37.86.1002 DENTAL SERVICES, REQUIREMENTS 7/2/1999 Rule 37.86.1003 reserved 37.86.1004 REIMBURSEMENT METHODOLOGY FOR RESOURCE BASED RELATIVE VALUE FOR DENTISTS (RVD) 7/1/2013 37.86.1005 DENTAL SERVICES, REIMBURSEMENT 1/21/2017 37.86.1006 DENTAL SERVICES, COVERED PROCEDURES 10/1/2019 Subchapter 11 Outpatient Drug Services 37.86.1101 OUTPATIENT DRUGS, DEFINITIONS 10/20/2018 37.86.1102 OUTPATIENT DRUGS, REQUIREMENTS 9/21/2019 37.86.1103 OUTPATIENT DRUGS, FRAUD, WASTE, AND ABUSE 9/21/2019 Rule 37.86.1104 reserved 37.86.1105 OUTPATIENT DRUGS, REIMBURSEMENT 10/20/2018 37.86.1106 CALCULATION OF THE AVERAGE ACQUISITION COST 7/1/2016 37.86.1111 OPPORTUNITY FOR HEARING 1/1/2009 Subchapter 12 Licensed Direct-Entry Midwife 37.86.1201 LICENSED DIRECT-ENTRY MIDWIFE 9/9/2017 Subchapter 14 Ambulatory Surgical Centers 37.86.1401 CLINIC SERVICES, DEFINITIONS 7/1/2014 37.86.1402 CLINIC SERVICES, REQUIREMENTS 3/30/2019 Rules 37.86.1403 and 37.86.1404 reserved 37.86.1405 CLINIC SERVICES, COVERED PROCEDURES 7/1/2014 37.86.1406 CLINIC SERVICES, REIMBURSEMENT 10/20/2018 Subchapter 15 Home Infusion Therapy Services 37.86.1501 HOME INFUSION THERAPY SERVICES, DEFINITIONS 7/1/2012 37.86.1502 HOME INFUSION THERAPY SERVICES, PROVIDER REQUIREMENTS 7/1/2012 Rules 37.86.1503 and 37.86.1504 reserved 37.86.1505 HOME INFUSION THERAPY SERVICES, REQUIREMENTS 10/4/1996 37.86.1506 HOME INFUSION THERAPY SERVICES, REIMBURSEMENT 7/1/2013 Subchapter 16 reserved Subchapter 17 Family Planning Services 37.86.1701 FAMILY PLANNING SERVICES 1/1/2013 Rules 37.86.1702 through 37.86.1704 reserved 37.86.1705 FAMILY PLANNING SERVICES, REQUIREMENTS 5/1/2012 37.86.1706 FAMILY PLANNING SERVICES, REIMBURSEMENT 5/1/2012 Subchapter 18 Prosthetic Devices, Durable Medical Equipment, and Medical Supplies 37.86.1801 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, DEFINITIONS 1/1/2009 37.86.1802 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, GENERAL REQUIREMENTS 8/8/2020 Rules 37.86.1803 through 37.86.1805 reserved 37.86.1806 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, REIMBURSEMENT REQUIREMENTS 1/27/2018 37.86.1807 PROSTHETIC DEVICES, DURABLE MEDICAL EQUIPMENT, AND MEDICAL SUPPLIES, FEE SCHEDULE 10/20/2018 Subchapter 19 reserved Subchapter 20 Optometric Services 37.86.2001 OPTOMETRIC SERVICES, DEFINITIONS 7/22/1997 37.86.2002 OPTOMETRIC SERVICES, REQUIREMENTS 3/1/2018 Rules 37.86.2003 and 37.86.2004 reserved 37.86.2005 OPTOMETRIC SERVICES, REIMBURSEMENT 10/20/2018 Subchapter 21 Eyeglass Services 37.86.2101 EYEGLASSES, DEFINITIONS 7/22/1997 37.86.2102 EYEGLASSES, SERVICES, REQUIREMENTS AND RESTRICTIONS 3/1/2018 Rules 37.86.2103 and 37.86.2104 reserved 37.86.2105 EYEGLASSES, REIMBURSEMENT 12/1/2016 Subchapter 22 Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) 37.86.2201 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , PURPOSE, ELIGIBILITY, AND SCOPE 6/27/2003 Rules 37.86.2202 through 37.86.2204 reserved 37.86.2205 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , REQUIRED SCREENING AND PREVENTIVE SERVICES 7/22/2017 37.86.2206 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , MEDICAL AND OTHER SERVICES 7/1/2013 37.86.2207 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT (EPSDT) SERVICES, REIMBURSEMENT 7/1/2013 Rule 37.86.2208 reserved 37.86.2209 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , NUTRITION SERVICES 1/12/2001 Rule 37.86.2210 reserved 37.86.2211 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , CHIROPRACTIC SERVICES 7/22/2017 Rule 37.86.2212 reserved 37.86.2213 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , OUTPATIENT CHEMICAL DEPENDENCY TREATMENT SERVICES REP 4/25/2003 Rules 37.86.2214 through 37.86.2216 reserved 37.86.2217 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), PRIVATE DUTY NURSING SERVICES 7/28/2006 Rule 37.86.2218 reserved 37.86.2219 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , THERAPEUTIC YOUTH GROUP HOME SERVICES REP 1/15/2011 Rule 37.86.2220 reserved 37.86.2221 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , THERAPEUTIC FAMILY CARE TREATMENT SERVICES REP 1/15/2011 Rules 37.86.2222 and 37.86.2223 reserved 37.86.2224 EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT SERVICE (EPSDT), COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT REP 7/1/2013 37.86.2225 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), CSCT PROGRAM BILLING REP 7/1/2013 Rules 37.86.2226 through 37.86.2229 reserved 37.86.2230 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), SCHOOL-BASED HEALTH RELATED SERVICES 7/1/2013 37.86.2231 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , ELIGIBILITY AND SCOPE OF SCHOOL BASED HEALTH RELATED SERVICES 6/27/2003 37.86.2232 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , SCHOOL BASED PERSONAL CARE PARAPROFESSIONAL SERVICES 6/27/2003 37.86.2233 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , SCHOOL PSYCHOLOGIST SERVICES 6/27/2003 37.86.2234 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , SCHOOL-BASED SPECIALIZED TRANSPORTATION SERVICES 1/1/2004 37.86.2235 EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT), ORIENTATION AND MOBILITY SPECIALIST SERVICES 7/1/2013 Subchapter 23 reserved Subchapter 24 Transportation Services 37.86.2401 TRANSPORTATION AND PER DIEM, DEFINITIONS 11/9/2012 37.86.2402 TRANSPORTATION AND PER DIEM, REQUIREMENTS 7/1/2015 Rules 37.86.2403 and 37.86.2404 reserved 37.86.2405 TRANSPORTATION AND PER DIEM, REIMBURSEMENT 7/1/2013 Subchapter 25 Specialized Nonemergency Medical Transportation 37.86.2501 SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, DEFINITIONS 11/9/2012 37.86.2502 SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, REQUIREMENTS 6/13/2003 Rules 37.86.2503 and 37.86.2504 reserved 37.86.2505 SPECIALIZED NONEMERGENCY MEDICAL TRANSPORTATION, REIMBURSEMENT 7/1/2013 Subchapter 26 Ambulance Services 37.86.2601 AMBULANCE SERVICES, DEFINITIONS 6/13/2003 37.86.2602 AMBULANCE SERVICES, REQUIREMENTS 7/1/2015 Rule 37.86.2603 reserved 37.86.2604 AMBULANCE SERVICES, COVERAGE AND BILLABLE SERVICES 7/6/2001 37.86.2605 AMBULANCE SERVICES, REIMBURSEMENT 10/20/2018 37.86.2606 AMBULANCE SERVICES, QUALIFIED RATE ADJUSTMENT, PAYMENT ELIGIBILITY AND COMPUTATION 7/1/2015 Subchapter 27 reserved Subchapter 28 Reimbursement 37.86.2801 ALL HOSPITAL REIMBURSEMENT, GENERAL 7/1/2014 Rule 37.86.2802 reserved 37.86.2803 ALL HOSPITAL REIMBURSEMENT, COST REPORTING 10/20/2018 Rules 37.86.2804 and 37.86.2805 reserved 37.86.2806 COST-BASED HOSPITAL, GENERAL REIMBURSEMENT 10/20/2018 Rules 37.86.2807 through 37.86.2809 reserved 37.86.2810 INPATIENT AND OUTPATIENT HOSPITAL SERVICES, QUALIFIED RATE ADJUSTMENT PAYMENT, ELIGIBILITY, AND COMPUTATION REP 7/1/2010 Rules 37.86.2811 through 37.86.2819 reserved 37.86.2820 DESK REVIEWS, OVERPAYMENTS, AND UNDERPAYMENTS 7/1/2014 Subchapter 29 Inpatient Hospital Services 37.86.2901 INPATIENT HOSPITAL SERVICES, DEFINITIONS 1/1/2020 37.86.2902 INPATIENT HOSPITAL SERVICES, REQUIREMENTS 5/7/2016 37.86.2903 INPATIENT HOSPITAL SERVICES, EXCLUSIONS 7/1/2010 37.86.2904 INPATIENT HOSPITAL SERVICES, BILLING REQUIREMENTS 7/1/2010 37.86.2905 INPATIENT HOSPITAL SERVICES, GENERAL REIMBURSEMENT 10/20/2018 Rule 37.86.2906 reserved 37.86.2907 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION 7/1/2018 Rules 37.86.2908 and 37.86.2909 reserved 37.86.2910 INPATIENT HOSPITAL REIMBURSEMENT, QUALIFIED RATE ADJUSTMENT PAYMENT REP 7/1/2010 Rule 37.86.2911 reserved 37.86.2912 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, CAPITAL-RELATED COSTS 10/20/2018 Rule 37.86.2913 reserved 37.86.2914 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, MEDICAL EDUCATION COSTS REP 10/1/2008 Rule 37.86.2915 reserved 37.86.2916 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, COST OUTLIERS 10/1/2016 Rule 37.86.2917 reserved 37.86.2918 INPATIENT HOSPITAL, READMISSIONS, PARTIAL ELIGIBILITY, OUTPATIENT BUNDLING, AND TRANSFERS FOR PROSPECTIVE PAYMENT SYSTEM (PPS) FACILITIES 3/1/2018 Rule 37.86.2919 reserved 37.86.2920 INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, HOSPITAL RESIDENTS 7/1/2010 37.86.2921 HOSPITAL RESIDENCY REQUIREMENTS 7/1/2010 Rules 37.86.2922 and 37.86.2923 reserved 37.86.2924 INPATIENT HOSPITAL COST BASED REIMBURSEMENT, CERTIFIED REGISTERED NURSE ANESTHETISTS 10/1/2008 37.86.2925 INPATIENT HOSPITAL REIMBURSEMENT, DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS 5/26/2018 Rules 37.86.2926 and 37.86.2927 reserved 37.86.2928 INPATIENT HOSPITAL REIMBURSEMENT, HOSPITAL REIMBURSEMENT ADJUSTOR 1/1/2020 Rules 37.86.2929 and 37.86.2930 reserved 37.86.2931 ROUTINE DISPROPORTIONATE SHARE HOSPITAL 5/26/2018 37.86.2932 MEDICAID UTILIZATION RATE 5/26/2018 Rules 37.86.2933 and 37.86.2934 reserved 37.86.2935 CALCULATING LOW INCOME UTILIZATION RATE, FOR ROUTINE DISPROPORTIONATE SHARE HOSPITALS 2/27/2004 Rules 37.86.2936 through 37.86.2939 reserved 37.86.2940 HOSPITAL REIMBURSEMENT ADJUSTOR (HRA), DATA SOURCES 1/1/2020 Rules 37.86.2941 and 37.86.2942 reserved 37.86.2943 BORDER HOSPITAL REIMBURSEMENT 10/1/2008 Rules 37.86.2944 through 37.86.2946 reserved 37.86.2947 OUT-OF-STATE HOSPITAL AND CENTERS OF EXCELLENCE REIMBURSEMENT 7/1/2010 37.86.2950 GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM 9/26/2020 Subchapter 30 Outpatient Hospital Services 37.86.3001 OUTPATIENT HOSPITAL SERVICES, DEFINITIONS 1/1/2020 37.86.3002 OUTPATIENT HOSPITAL SERVICES, SCOPE AND REQUIREMENTS 12/25/2015 37.86.3003 OUTPATIENT HOSPITAL SERVICES, EXCLUSIONS 12/25/2015 Rule 37.86.3004 reserved 37.86.3005 OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT 7/13/2012 37.86.3006 MENTAL HEALTH OUTPATIENT PARTIAL HOSPITAL SERVICES, REQUIREMENTS 9/19/2014 37.86.3007 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, CLINICAL DIAGNOSTIC LABORATORY SERVICES 10/20/2018 Rule 37.86.3008 reserved 37.86.3009 OUTPATIENT HOSPITAL SERVICES, PAYMENT METHODOLOGY, EMERGENCY VISIT SERVICES 7/1/2014 Rule 37.86.3010 reserved 37.86.3011 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, NONEMERGENT EMERGENCY ROOM SERVICES REP 8/1/2003 Rules 37.86.3012 and 37.86.3013 reserved 37.86.3014 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, DIALYSIS SERVICES REP 7/13/2012 37.86.3015 OUTPATIENT HOSPITAL REIMBURSEMENT, OUTPATIENT HOSPITAL REIMBURSEMENT ADJUSTOR 1/1/2020 37.86.3016 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, IMAGING SERVICES 7/13/2012 Rule 37.86.3017 reserved 37.86.3018 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, OTHER DIAGNOSTIC SERVICES 7/13/2012 Rule 37.86.3019 reserved 37.86.3020 OUTPATIENT HOSPITAL SERVICES, OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (OPPS) METHODOLOGY, AMBULATORY PAYMENT CLASSIFICATION 7/1/2014 Rule 37.86.3021 reserved 37.86.3022 OUTPATIENT HOSPITAL SERVICES, PARTIAL HOSPITALIZATION SERVICES 3/24/2006 Rules 37.86.3023 and 37.86.3024 reserved 37.86.3025 OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT FOR SERVICES NOT PAID UNDER THE AMBULATORY PAYMENT CLASSIFICATION SYSTEM 3/1/2018 Rules 37.86.3026 through 37.86.3030 reserved 37.86.3031 PROVIDER BASED ENTITY SERVICES, GENERAL REP 3/1/2018 Rule 37.86.3032 reserved 37.86.3033 PROVIDER-BASED ENTITY SERVICES, RECIPIENT ACCESS AND NOTIFICATION REP 3/1/2018 Rule 37.86.3034 reserved 37.86.3035 PROVIDER BASED ENTITY SERVICES, COMPLIANCE, AND PENALTIES REP 3/1/2018 Rule 37.86.3036 reserved 37.86.3037 PROVIDER-BASED ENTITY SERVICES, REIMBURSEMENT REP 3/1/2018 Subchapter 31 Outpatient Hospital Rehabilitation and Therapy Services 37.86.3101 OUTPATIENT HOSPITAL SERVICES, CARDIAC AND PULMONARY REHABILITATION SERVICES 7/1/2014 Rule 37.86.3102 reserved 37.86.3103 OUTPATIENT HOSPITAL SERVICES, CARDIAC REHABILITATION SERVICES 5/7/2016 Rule 37.86.3104 reserved 37.86.3105 OUTPATIENT HOSPITAL SERVICES, PULMONARY REHABILITATION SERVICES 5/7/2016 Rule 37.86.3106 reserved 37.86.3107 OUTPATIENT HOSPITAL SERVICES, CARDIAC AND PULMONARY REHABILITATION, WAIVER OF SERVICE LIMITATIONS 6/23/2006 Rule 37.86.3108 reserved 37.86.3109 OUTPATIENT CARDIAC AND PULMONARY REHABILITATION REIMBURSEMENT 10/20/2018 Subchapter 32 Nonhospital Laboratory and Radiology (X-Ray) Services 37.86.3201 NONHOSPITAL LABORATORY AND RADIOLOGY (X-RAY) SERVICES, REQUIREMENTS 1/1/2013 Rules 37.86.3202 through 37.86.3204 reserved 37.86.3205 NONHOSPITAL LABORATORY AND RADIOLOGY (X-RAY) SERVICES, REIMBURSEMENT 10/20/2018 Subchapter 33 Case Management Services - General 37.86.3301 CASE MANAGEMENT SERVICES, GENERAL DEFINITIONS 3/11/1997 Rules 37.86.3302 through 37.86.3304 reserved 37.86.3305 CASE MANAGEMENT SERVICES, GENERAL PROVISIONS 3/11/1997 37.86.3306 CASE MANAGEMENT SERVICES, GENERAL ELIGIBILITY 7/1/1999 Subchapter 34 Targeted Case Management Services for High Risk Pregnant Women 37.86.3401 TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, DEFINITIONS 10/14/2017 37.86.3402 TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, ELIGIBILITY 10/14/2017 Rules 37.86.3403 and 37.86.3404 reserved 37.86.3405 TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, COVERAGE 10/14/2017 Rules 37.86.3406 through 37.86.3409 reserved 37.86.3410 TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, PROVIDER REQUIREMENTS 10/14/2017 37.86.3411 CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, FINANCIAL RECORDS, AND REPORTING REP 10/14/2017 Rules 37.86.3412 through 37.86.3414 reserved 37.86.3415 TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, REIMBURSEMENT 10/14/2017 Subchapter 35 Targeted Case Management Services for Adults with Severe Disabling Mental Illness 37.86.3501 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, DEFINITIONS REP 5/1/2018 37.86.3502 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, ELIGIBILITY REP 5/1/2018 37.86.3503 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, SEVERE DISABLING MENTAL ILLNESS REP 5/1/2018 Rule 37.86.3504 reserved 37.86.3505 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, SERVICE COVERAGE REP 5/1/2018 37.86.3506 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, SERVICE REQUIREMENTS REP 5/1/2018 37.86.3507 CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, PROVIDER REQUIREMENTS REP 5/1/2018 Rules 37.86.3508 through 37.86.3514 reserved 37.86.3515 TARGETED CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, REIMBURSEMENT 5/1/2018 Subchapter 36 Case Management Services for Persons Age 16 and Over with Developmental Disabilities 37.86.3601 CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, DEFINITIONS 3/11/1997 37.86.3602 CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, ELIGIBILITY 3/11/1997 Rules 37.86.3603 and 37.86.3604 reserved 37.86.3605 CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, COVERAGE 3/11/1997 37.86.3606 CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, PROVIDER REQUIREMENTS 3/11/1997 37.86.3607 CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, REIMBURSEMENT 9/9/2023 Subchapter 37 Case Management Services for Youth with Serious Emotional Disturbance 37.86.3701 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, DEFINITIONS REP 2/27/2009 37.86.3702 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY REP 2/27/2009 Rules 37.86.3703 and 37.86.3704 reserved 37.86.3705 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, SERVICE COVERAGE REP 2/27/2009 37.86.3706 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, SERVICE REQUIREMENTS REP 2/27/2009 37.86.3707 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, PROVIDER REQUIREMENTS REP 2/27/2009 Rules 37.86.3708 through 37.86.3714 reserved 37.86.3715 CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, REIMBURSEMENT REP 2/27/2009 Subchapter 38 Case Management Services for Children at Risk of Abuse and Neglect 37.86.3801 CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, DEFINITIONS REP 10/14/2017 Rules 37.86.3802 through 37.86.3804 reserved 37.86.3805 CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, COVERAGE REP 10/14/2017 37.86.3806 MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, ELIGIBILITY REP 10/14/2017 Rules 37.86.3807 through 37.86.3809 reserved 37.86.3810 MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, PROVIDER REQUIREMENTS REP 10/14/2017 37.86.3811 MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, REIMBURSEMENT REP 10/14/2017 Subchapter 39 Targeted Case Management Services for Children with Special Health Care Needs 37.86.3901 TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, DEFINITIONS 10/14/2017 37.86.3902 TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, ELIGIBILITY 3/1/2018 Rules 37.86.3903 and 37.86.3904 reserved 37.86.3905 TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, COVERAGE 10/14/2017 37.86.3906 TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, PROVIDER REQUIREMENTS 3/1/2018 Rules 37.86.3907 through 37.86.3909 reserved 37.86.3910 TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, REIMBURSEMENT 10/14/2017 Subchapter 40 Targeted Case Management Services for Substance Use Disorders 37.86.4001 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, DEFINITIONS 3/1/2013 37.86.4002 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, ELIGIBILITY 3/1/2013 37.86.4005 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, SERVICE COVERAGE 3/1/2013 37.86.4006 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, SERVICE REQUIREMENTS 3/1/2013 37.86.4007 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, PROVIDER REQUIREMENTS 3/1/2013 37.86.4010 TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, REIMBURSEMENT 7/1/2013 Subchapter 41 reserved Subchapter 42 Dialysis Clinics for End Stage Renal Disease 37.86.4201 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, DEFINITIONS 10/28/2011 37.86.4202 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REQUIREMENTS 7/1/2014 Rules 37.86.4203 and 37.86.4204 reserved 37.86.4205 DIALYSIS CLINICS FOR END STAGE RENAL DISEASE, REIMBURSEMENT 7/1/2014 Subchapter 43 reserved Subchapter 44 Rural Health Clinics and Federally Qualified Health Centers 37.86.4401 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, DEFINITIONS 9/25/2021 37.86.4402 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, VISITS AND ENCOUNTERS 10/19/2019 Rules 37.86.4403 and 37.86.4404 reserved 37.86.4405 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, PROVIDER PARTICIPATION REQUIREMENTS 10/12/2001 37.86.4406 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, SERVICE REQUIREMENTS 10/19/2019 37.86.4407 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, RECORD KEEPING AND REPORTS 6/17/2005 37.86.4408 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, REQUIREMENTS FOR CHANGE IN SCOPE OF SERVICE REQUEST 10/19/2019 37.86.4409 PROSPECTIVE CHANGE IN SCOPE OF SERVICE 10/19/2019 37.86.4410 RETROSPECTIVE CHANGE IN SCOPE OF SERVICE 10/19/2019 Rule 37.86.4411 reserved 37.86.4412 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, REIMBURSEMENT 10/19/2019 37.86.4413 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, ESTABLISHMENT OF INTERIM PAYMENT FOR NEW RHC OR FQHC 10/19/2019 37.86.4414 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, SUPPLEMENTAL PAYMENTS IN CASE OF MANAGED CARE 10/12/2001 Rules 37.86.4415 through 37.86.4419 reserved 37.86.4420 RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, ALTERNATIVE PAYMENT METHODOLOGIES 10/19/2019 Subchapter 45 Promising Pregnancy Care 37.86.4501 PROMISING PREGNANCY CARE - DEFINITIONS 12/9/2017 37.86.4502 PROMISING PREGNANCY CARE - GENERAL PROVISIONS 12/9/2017 37.86.4503 PROMISING PREGNANCY CARE - REIMBURSEMENT 12/9/2017 Subchapter 46 reserved Subchapter 47 Organ Transplant Services 37.86.4701 ORGAN TRANSPLANTATION, DEFINITIONS 10/16/2009 Rules 37.86.4702 through 37.86.4704 reserved 37.86.4705 ORGAN TRANSPLANTATION, REQUIREMENTS 10/16/2009 37.86.4706 ORGAN TRANSPLANTATION, REIMBURSEMENT 10/16/2009 Subchapter 48 reserved Subchapter 49 reserved Subchapter 50 Health Maintenance Organizations (HMO) 37.86.5001 HEALTH MAINTENANCE ORGANIZATIONS: DEFINITIONS 3/31/2000 37.86.5002 HEALTH MAINTENANCE ORGANIZATIONS: RECIPIENT ELIGIBILITY 3/31/2000 Rules 37.86.5003 and 37.86.5004 reserved 37.86.5005 HEALTH MAINTENANCE ORGANIZATIONS: ENROLLMENT 3/31/2000 37.86.5006 HEALTH MAINTENANCE ORGANIZATIONS: DISENROLLMENT 3/31/2000 37.86.5007 HEALTH MAINTENANCE ORGANIZATIONS: COVERED SERVICES 3/31/2000 Rules 37.86.5008 and 37.86.5009 reserved 37.86.5010 HEALTH MAINTENANCE ORGANIZATIONS: CONTRACTS FOR SERVICES 3/31/2000 37.86.5011 HEALTH MAINTENANCE ORGANIZATIONS: PROVISION OF SERVICES 3/31/2000 37.86.5012 HEALTH MAINTENANCE ORGANIZATIONS: PARTICIPATING PROVIDERS 6/30/2000 37.86.5013 HEALTH MAINTENANCE ORGANIZATIONS: REIMBURSEMENT OF PROVIDERS 7/8/1997 37.86.5014 HEALTH MAINTENANCE ORGANIZATIONS: REIMBURSEMENT OF HMOS 3/31/2000 Rules 37.86.5015 through 37.86.5019 reserved 37.86.5020 HEALTH MAINTENANCE ORGANIZATIONS: ACCESS TO SERVICES 3/31/2000 Rules 37.86.5021 through 37.86.5024 reserved 37.86.5025 HEALTH MAINTENANCE ORGANIZATIONS: GRIEVANCE PROCEDURES 6/30/2000 37.86.5026 HEALTH MAINTENANCE ORGANIZATIONS: RECORDS AND CONFIDENTIALITY 3/31/2000 37.86.5027 HEALTH MAINTENANCE ORGANIZATIONS: RECIPIENT EDUCATION 7/8/1997 Rules 37.86.5028 through 37.86.5034 reserved 37.86.5035 HEALTH MAINTENANCE ORGANIZATIONS: QUALITY ASSURANCE 3/31/2000 37.86.5036 HEALTH MAINTENANCE ORGANIZATIONS: THIRD PARTY 9/29/1995 Subchapter 51 Passport to Health Program 37.86.5101 PASSPORT TO HEALTH PROGRAM: AUTHORITY 8/9/2013 37.86.5102 PASSPORT TO HEALTH PROGRAM: DEFINITIONS 4/1/2018 37.86.5103 PASSPORT TO HEALTH PROGRAM: ELIGIBILITY 8/9/2013 37.86.5104 PASSPORT TO HEALTH PROGRAM: ENROLLMENT IN THE PROGRAM 8/9/2013 Rules 37.86.5105 through 37.86.5109 reserved 37.86.5110 PASSPORT TO HEALTH PROGRAM: SERVICES 10/30/2015 37.86.5111 PASSPORT TO HEALTH PROGRAM: PRIMARY CARE PROVIDERS REQUIREMENTS 1/17/2014 37.86.5112 PASSPORT TO HEALTH PROGRAM: REIMBURSEMENT 4/1/2018 Rules 37.86.5113 through 37.86.5119 reserved 37.86.5120 PASSPORT TO HEALTH PROGRAM: FAIR HEARING 6/30/2000 Subchapter 52 Health Improvement Program 37.86.5201 HEALTH IMPROVEMENT PROGRAM: DEFINITIONS REP 4/1/2018 37.86.5202 HEALTH IMPROVEMENT PROGRAM: GENERAL REP 4/1/2018 Rule 37.86.5203 reserved 37.86.5204 CRITERIA FOR DETERMINING MEDICAID AND HEALTHY MONTANA KIDS PLUS (HMK PLUS) ELIGIBLE INDIVIDUALS MANAGED UNDER THE HEALTH IMPROVEMENT PROGRAM REP 4/1/2018 37.86.5205 HEALTH IMPROVEMENT PROGRAM: CLIENT ELIGIBILITY AND ASSIGNMENT REP 4/1/2018 37.86.5206 HEALTH IMPROVEMENT PROGRAM: SCOPE OF SERVICES AND REIMBURSEMENT REP 4/1/2018 Subchapter 53 Passport to Health Team Care Program Rules 37.86.5301 and 37.86.5302 reserved 37.86.5303 PASSPORT TO HEALTH'S TEAM CARE PROGRAM 7/23/2004 Rules 37.86.5304 and 37.86.5305 reserved 37.86.5306 TEAM CARE PROGRAM: REIMBURSEMENT 7/23/2004 Subchapter 54 Preventive Services 37.86.5401 PURPOSE 8/24/2012 37.86.5402 DEFINITIONS 8/24/2012 37.86.5403 DIABETES AND CARDIOVASCULAR DISEASE PREVENTION SERVICES GENERAL 8/24/2012 37.86.5404 DIABETES AND CARDIOVASCULAR DISEASE PREVENTION SERVICES REIMBURSEMENT 8/24/2012