Section 9-9 - Inpatient hospital services (a) Covered services. Subject to the service limitations of Section 11, inpatient hospital services are covered services if provided: - (i) Pursuant to the written orders of a physician;
- (ii) By or under the supervision of a physician; and
- (iii) Subject to subsections (b) and (c)
(b) Excluded services. - (i) Abortions, except to the extent required by federal law;
- (ii) Alcohol and chemical dependency rehabilitation services;
- (iii) Non-covered services provided as part of a recipient's treatment for covered services;
- (iv) Nursing facility services, except as provided by Chapter 28;
- (v) Oxygen or other supplies specified in Attachment A to Chapter 7 that are provided to a recipient for use in a nursing facility;
- (vi) Court ordered medical services that are:
- (A) Not covered services;
- (B) In excess of service limitations;
- (C) Have not received admission certification;
- (D) Have not received prior authorization, if so required; or
- (E) Furnished by a hospital that is not a provider on the date(s) of service;
- (vii) Services provided pursuant to standing orders, including, but not limited to, routine laboratory or radiology procedures;
- (viii) Services provided to a person who is an inmate of a public institution or an individual that is in the custody of a state, local, or federal law enforcement agency;
- (ix) Services provided to an individual in emergency detention;
- (x) Sterilizations which are not provided in conformance with the requirements of 42 C.F.R. 442 Subpart F, which is adopted by this reference; and
- (xi) Other services as specified in Chapter 26.
(c) Limited services: - (i) Alcohol and chemical dependency services. Treatment for alcohol and chemical dependency is limited to detoxification and/or stabilization of acute conditions;
- (ii) Psychiatric services. Except as provided pursuant to Chapter 6, psychiatric services are limited to stabilization of acute conditions. Such services are not covered services unless:
- (A) The recipient is evaluated by a multidisciplinary team within 48 hours after admission;
- (B) The multidisciplinary team prepares an individualized treatment plan; and
- (C) The medical record documents a plan of active treatment and individual, group or family therapy directed to achieve the goals specified in the individualized treatment plan.