37.83.831    QUALIFIED MEDICARE BENEFICIARIES, DETERMINATION OF MEDICAL NECESSITY

(1) For services to qualified medicare beneficiaries, medicaid may accept medicare's determination of medical necessity for services which require approval prior to service delivery or review prior to payment. Medicaid may also accept medicare's determination of whether a medical procedure is experimental or not.

(2) The department will only pay for medically necessary, non-experimental services, as established in ARM 37.82.102(2) and ARM 37.85.410.

History: Sec. 53-2-201 and 53-6-113, MCA; IMP, Sec. 53-6-101 and 53-6-131, MCA; NEW, 1989 MAR p. 835, Eff. 6/30/89; TRANS, from SRS, 2000 MAR p. 197.