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

   1. (a) attendant or back-up person;
   2. (b) drugs not specifically listed in ARM 37.55.502 as eligible medications;
   3. (c) transportation for anyone other than a cadaveric transplant patient;
   4. (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;
   5. (e) any transportation for living related donor;
   6. (f) services provided which are not related to kidney condition, e.g., epistaxis, otitis media, diabetes, eye examinations, and heart evaluations;
   7. (g) medicare premiums;
   8. (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) ;
   9. (i) access-site surgery prior to initiation of dialysis treatments; and
   10. (j) medicaid copayments or medicaid deductibles.

Authorizing statute(s): Sec. 50-44-102 and 53-6-202, MCA

Implementing statute(s): Sec. 50-44-102 and 53-6-202, MCA

History: NEW, 1984 MAR p. 41, Eff. 1/13/84; AMD, 1987 MAR p. 1790, Eff. 10/16/87; TRANS & AMD, from DHES, 2000 MAR p. 1660, Eff. 6/30/00.