Chapter 130. Amount, Duration and Scope of Selected ServicesRead Chapter
- Part I. Outpatient Physical Rehabilitative Services (Repealed)Read all
- Section 10
- [Repealed]
- Section 15
- [Repealed]
- Section 20
- [Repealed]
- Section 30
- [Repealed]
- Section 40
- [Repealed]
- Section 42
- [Repealed]
- Section 50
- [Repealed]
- Section 60
- [Repealed]
- Section 70
- [Repealed]
- Part II. Long-Stay Acute Care HospitalsRead all
- Section 80
- Scope
- Section 90
- Authorization for services
- Section 100
- Criteria for long-stay acute care hospital stays
- Section 110
- Documentation requirements
- Section 120
- Long-stay acute care hospital services
- Section 130
- Long-stay acute care hospital requirements
- Part III. Preadmission Screening and Annual Resident ReviewRead all
- Section 140
- Definitions
- Section 150
- Persons subject to nursing home preadmission screening and identification of conditions of mental illness and mental retardation (Level I)
- Section 160
- Level II determination
- Section 170
- Categorical determinations
- Section 180
- Annual resident review
- Section 190
- Determinations and placement of individuals with MI or MR/RC
- Section 200
- PASARR evaluation criteria
- Section 210
- Specialized services
- Section 220
- Placement options
- Section 230
- Evaluating the need for NF services and NF level of care (PASARR/NF)
- Section 240
- Evaluating whether an individual with MI requires specialized services (PASARR/MI)
- Section 250
- Evaluating whether an individual with MR/RC requires specialized services (PASARR/MR)
- Section 260
- Appeals
- Part IV. Drug Utilization Review ProgramRead all
- Section 270
- Definitions
- Section 280
- Authority
- Section 290
- Scope and purpose
- Section 300
- Retrospective DUR
- Section 310
- Prospective DUR
- Section 320
- Criteria and standards for DUR
- Section 330
- Educational program
- Section 335
- Other interventions
- Section 340
- DUR Board
- Section 350
- DUR Committee
- Section 360
- Exemption of organized health care settings
- Section 370
- [Repealed]
- Part V. Drug Utilization Review in Nursing FacilitiesRead all
- Section 380
- Definitions
- Section 390
- Scope
- Section 400
- Utilization review process
- Section 410
- [Repealed]
- Section 420
- Medical quality assurance
- Part VI. Criteria for Intermediate Care for Mentally Retarded PersonsRead all
- Section 430
- Introduction
- Section 440
- Definitions
- Section 450
- Patient assessment criteria
- Section 460
- Directions for applying the criteria
- Part VII. Hospice Services [Repealed]Read all
- Section 470
- [Repealed]
- Part VIII. Community Mental Health and Mental Retardation ServicesRead all
- Section 540
- [Repealed]
- Section 550
- [Repealed]
- Section 560
- [Repealed]
- Section 565
- [Repealed]
- Section 570
- [Repealed]
- Section 580
- [Repealed]
- Section 590
- [Repealed]
- Part IX. DMAS-122 Adjustment ProcessRead all
- Section 600
- Definitions
- Section 610
- Purpose and scope
- Section 620
- Limitations
- Part X. New Drug Review Program Regulations [Repealed]Read all
- Section 630
- [Repealed]
- Part XI. New Drugs Not Covered by Medicaid [Repealed]Read all
- Section 730
- [Repealed]
- Part XII. Health Insurance Premium Payment Program (HIPP)Read all
- Section 740
- General
- Section 750
- Time frames for determining cost effectiveness
- Section 760
- Notices
- Section 770
- [Reserved]
- Section 780
- [Repealed]
- Section 790
- Information required of applicants and recipients
- Part XIII. Client Medical Management ProgramsRead all
- Section 800
- Definitions
- Section 810
- Client Medical Management Program for individuals
- Section 820
- Client Medical Management Program for providers
- Part XIV. Residential Psychiatric Treatment for Children and Adolescents (Repealed)Read all
- Section 850
- [Repealed]
- Section 860
- [Repealed]
- Section 870
- [Repealed]
- Section 880
- [Repealed]
- Section 890
- [Repealed]
- Part XV. Case Management Treatment Foster Care ServicesRead all
- Section 900
- Definitions
- Section 910
- Targeted case management for foster care children in treatment foster care (TFC) covered services
- Section 920
- Provider qualifications
- Section 930
- Organization and administration requirements
- Section 940
- Discharge from care
- Section 950
- Entries in case records
- Part XVI. Pharmacy Services Prior AuthorizationRead all
- Section 1000
- Pharmacy services prior authorization
- Part XVII. Marketing of Provider ServicesRead all
- Section 2000
- Marketing requirements and restrictions
- Section 3000
- [Repealed]
- Section 3010
- [Repealed]
- Section 3020
- [Repealed]
- Section 3030
- [Repealed]
- Part XX. Addiction and Recovery Treatment ServicesRead all
- Section 5000
- Addiction and recovery treatment services
- Section 5010
- Addiction and recovery treatment services; purpose
- Section 5020
- Definitions
- Section 5030
- Eligible individuals
- Section 5040
- Covered services: requirements; limits; standards
- Section 5050
- Covered services: clinic services - opioid treatment program services
- Section 5060
- Covered services: clinic services - preferred office-based opioid treatment
- Section 5070
- Covered services: practitioner services - early intervention/screening brief intervention and referral to treatment (ASAM Level 0.5)
- Section 5080
- Covered services: outpatient services - physician services (ASAM Level 1.0)
- Section 5090
- Covered services: community based services - intensive outpatient services (ASAM Level 2.1)
- Section 5100
- Covered services: community based care - partial hospitalization services (ASAM Level 2.5)
- Section 5110
- Covered services: clinically managed low intensity residential services (ASAM Level 3.1)
- Section 5120
- Covered services: clinically managed population - specific high intensity residential service (ASAM Level 3.3)
- Section 5130
- Covered services: clinically managed high intensity residential services (adult) and clinically managed medium intensity residential services...
- Section 5140
- Covered services: medically monitored intensive inpatient services (adult) and medically monitored high intensity inpatient services (adolescent)...
- Section 5150
- Covered services: medically managed intensive inpatient services (ASAM Level 4.0)
- Section 5160
- Peer support services and family support partners: definitions
- Section 5170
- Peer support services and family support partners: service definitions
- Section 5180
- Peer support services and family support partners: medical necessity criteria
- Section 5190
- Peer support services and family support partners: provider and setting requirements
- Section 5200
- Peer support services and family support partners: documentation of required activities
- Section 5210
- Peer support services and family support partners: limitations and exclusions to service delivery