(1) Inpatient hospital services do not include:

(a) services excluded from coverage by the Medicaid program under ARM 37.85.207;

(b) experimental or investigational services such as, the use of off-label drugs where this usage is not a national standard of practice, or non-FDA approved use of drugs, biologicals, and devices;

(c) services that do not comply with national standards of medical care; and

(d) inpatient hospital services provided outside the borders of the United States will not be covered or reimbursed by the Montana Medicaid program.