37.86.3101    OUTPATIENT HOSPITAL SERVICES, CARDIAC AND PULMONARY REHABILITATION SERVICES

(1) Coverage for medically necessary outpatient cardiac and pulmonary rehabilitation services is effective January 1, 2006.

(2) All cardiac and pulmonary rehabilitative services must be medically necessary and prior authorized by the department's designated review organization.

(3) The following conditions are contraindications to cardiac or pulmonary rehabilitation, and except as provided in ARM 37.86.3107, patients with one or more contraindications are not eligible for cardiac or pulmonary rehabilitation:

(a) severe psychiatric disturbance including, but not limited to, dementia and organic brain syndrome; or

(b) significant or unstable medical conditions including, but not limited to, substance abuse, liver dysfunction, kidney dysfunction, and metastatic cancer.

History: 53-2-201, 53-6-111, MCA; IMP, 53-2-201, 53-6-101, MCA; NEW, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2014 MAR p. 1415, Eff. 7/1/14.