(1) The cost of the following services and supplies is not eligible for payment from ESRD:

(a) attendant or back-up person;

(b) drugs not specifically listed in ARM 37.55.502 as eligible medications;

(c) transportation for anyone other than a cadaveric transplant patient;

(d) out-of-state dialysis care unless the care is directly related to a kidney transplant or a medical referral has been made by the patient's managing Montana nephrologist;

(e) any transportation for living related donor;

(f) services provided which are not related to kidney condition, e.g., epistaxis, otitis media, diabetes, eye examinations, and heart evaluations;

(g) medicare premiums;

(h) hospital in-patient care of over 60 days unless specifically justified as ESRD-related (e.g., not due to chronic debilitating disease other than renal disease) ;

(i) access-site surgery prior to initiation of dialysis treatments; and

(j) medicaid copayments or medicaid deductibles.