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Department of Human Services
Michelle R.B. Saddler, Secretary
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Policy Manual Chapter Table of Contents
PM 20: Medical Program
WAG 20.
PM 20-01-00: Medical Benefits (TANF, AABD, GA)
– 07/01/97
PM 20-01-01: Freedom of Choice
– 07/01/97
PM 20-01-02: Restriction of Choice
– 03/01/97
PM 20-02-00: Persons Eligible
– 07/01/97
PM 20-02-01: Eligibility by Program
– 05/16/05 MR 05.25
PM 20-02-02: People in Jail
– 07/16/12 MR 12.19
PM 20-03-00 Department Responsibilities (AABD, TANF, GA)
– 01/01/98
PM 20-03-01: Prior Approval
– 03/01/97
PM 20-03-02: Immediate Approval (Emergencies)
– 03/01/97
PM 20-03-03: Post Approval
– 03/01/97
PM 20-03-04: Payment
– 02/05/99
PM 20-03-04-a: Client Copays
– 07/01/03
PM 20-03-04-b: Payment of Deductibles and Coinsurance
– 02/05/99
PM 20-03-04-c: Services Not Covered
– 02/05/99
PM 20-04-00: Medical Providers (AABD, TANF, GA)
– 07/01/97
PM 20-04-01: Provider Responsibilities
– 03/01/97
PM 20-04-01-a: Verifying Eligibility
– 03/01/97
PM 20-04-01-b: Record Keeping
– 03/01/97
PM 20-04-01-c: Billing
– 03/01/97
PM 20-04-01-d: Nondiscrimination
– 03/01/97
PM 20-04-02: Provider Requirements
– 03/01/97
PM 20-05-00: Recipient Restriction Program (AABD, TANF, GA)
– 07/01/97
PM 20-05-01: Notice of Restriction
– 03/01/97
PM 20-05-02: Right to Appeal
– 03/01/97
PM 20-05-03: Primary Care Providers
– 03/01/97
PM 20-05-03-a: Provider Duties
– 03/01/97
PM 20-05-03-b: Changing Primary Care Providers
– 03/01/97
PM 20-05-04: Restriction Period
– 03/01/13 MR 13.06
PM 20-05-05: Reevaluating the Restriction
– 03/01/97
PM 20-06-00: Hospital (TANF, AABD, GA)
– 07/01/97
PM 20-06-01: Providers
– 07/01/97
PM 20-06-02: Payment
– 03/01/97
PM 20-07-00: Physicians (TANF, AABD, GA)
– 07/01/97
PM 20-07-01: Providers
– 03/01/97
PM 20-07-02: Payment
– 03/01/97
PM 20-08-00: Long Term Care/Supportive Living (AABD)
– 04/17/98
PM 20-08-01: Providers
– 04/17/98
PM 20-08-02: Supportive Living Facility (SLF) Services
– 04/17/98
PM 20-08-03: Long Term Care (LTC) Services
– 04/17/98
PM 20-08-03-a: Skilled Nursing Facilities (SNF)
– 03/01/97
PM 20-08-03-b: Intermediate Care Facilities (ICF)
– 03/01/97
PM 20-08-03-c: Intermediate Care Facilities/Mentally Retarded (ICF/MR)
– 03/01/97
PM 20-08-03-d: Department of Human Services (DHS) Facilities
– 04/17/98
PM 20-08-04: Screening
– 04/25/06 MR 06.13
PM 20-08-04-a: Second Opinion
– 06/01/05
PM 20-08-04-b: Appeal of Screening Decision
– 04/17/98
PM 20-08-05: Reserved
– 06/01/05
PM 20-08-06: Reserved
– 06/01/05
PM 20-08-07: Transfers Between Facilities
– 03/01/97
PM 20-08-07-a: Involuntary Transfers
– 04/17/98
PM 20-08-07-b: Emergency Transfers Ordered By Public Health/Healthcare and Family Services
– 04/17/98
PM 20-08-07-c: Transfers That Endanger Health (Long Term Care)
– 04/17/98
PM 20-08-08: Voluntary Withdrawal
– 04/17/98
PM 20-08-09: Continued Payment
– 04/17/98
PM 20-08-10: Resident Contracts
– 04/17/98
PM 20-08-11: Resident Funds
– 04/17/98
PM 20-08-11-a: Funds Managed by Client
– 03/01/97
PM 20-08-11-b: Funds Managed by Guardian
– 03/01/97
PM 20-08-11-c: Funds Managed by Facility (Long Term Care)
– 06/01/05
PM 20-08-11-d: Family Community Resource Center Responsibilities
– 03/01/97
PM 20-08-12: Absence from Facility (Long Term Care)
– 07/01/03
PM 20-08-13: Suspected Abuse and Neglect of Residents
– 04/17/98
PM 20-08-14: Payment
– 06/01/05
PM 20-08-14-a: Basic Rate (Long Term Care)
– 04/17/98
PM 20-08-14-b: Day Programming (Long Term Care)
– 04/17/98
PM 20-08-14-c: Exceptional Care (Long Term Care)
– 01/01/07
PM 20-08-14-d: Bed Reserve
– 02/07/13 MR 13.03
PM 20-08-15: Approval of Payment for Care
– 02/07/13 MR 13.03
PM 20-08-15-a: Adjustments for Incorrect Payments
– 03/01/97
PM 20-09-00: Clinics (TANF, AABD, GA)
– 07/01/97
PM 20-09-01: Providers
– 07/01/97
PM 20-09-02: Payment
– 03/01/97
PM 20-10-00: Physical Rehabilitation (TANF, AABD, GA)
– 07/01/97
PM 20-10-01: Providers
– 03/01/97
PM 20-10-02: Prior Approval
– 03/01/97
PM 20-10-03: Payment
– 03/01/97
PM 20-11-00: Nurse Midwife (TANF, AABD)
– 07/01/97
PM 20-11-01: Providers
– 03/01/97
PM 20-11-02: Payment
– 03/01/97
PM 20-12-00: Home Health Care (TANF, AABD, GA)
– 07/01/97
PM 20-12-01: Home Health Care (TANF, AABD, P3 TA, GA-FCA Children Under Age 18)
– 07/01/97
PM 20-12-01-a: Providers
– 03/01/97
PM 20-12-01-b: Prior Approval
– 03/01/97
PM 20-12-01-c: Payment
– 03/01/97
PM 20-12-02: Home Health Care Services for the Terminally Ill (GA)
– 03/01/97
PM 20-12-02-a: Providers
– 03/01/97
PM 20-12-02-b: Prior Approval
– 03/01/97
PM 20-12-02-c: Payment
– 03/01/97
PM 20-13-00: Eye Care (TANF, AABD, GA)
– 10/01/02
PM 20-13-01: Providers
– 03/01/97
PM 20-13-02: Prior Approval
– 10/01/02
PM 20-13-03: Payment
– 03/01/97
PM 20-14-00: Dental Care (TANF, FHP, AABD, GA)
– 12/01/09 MR 10.09
PM 20-14-01: Providers
– 12/01/09 MR 10.09
PM 20-14-02: Prior Approval
– 12/01/09 MR 10.09
PM 20-14-03: Payment
– 12/01/09 MR 10.09
PM 20-15-00: Podiatry (TANF, AABD, GA)
– 10/01/02
PM 20-15-01: Providers
– 03/01/97
PM 20-15-02: Prior Approval
– 03/01/97
PM 20-15-03: Payment
– 03/01/97
PM 20-16-00: Chiropractic (TANF, AABD, GA)
– 10/01/02
PM 20-16-01: Providers
– 03/01/97
PM 20-16-02: Payment
– 03/01/97
PM 20-17-00: Independent Laboratory and X-ray (TANF, AABD, GA)
– 07/01/97
PM 20-17-01: Providers
– 03/01/97
PM 20-17-02: Payment
– 03/01/97
PM 20-18-00: Drugs, Medical Supplies, and Sickroom Needs (TANF, AABD, GA)
– 07/01/97
PM 20-18-01: Providers
– 03/01/97
PM 20-18-02: Prior Approval
– 03/01/97
PM 20-18-02-a: Drugs
– 03/01/97
PM 20-18-02-b: Medical Supplies and Sickroom Needs
– 03/01/97
PM 20-18-03: Payment
– 03/01/97
PM 20-19-00: Medical Equipment and Prosthetic Devices (TANF, AABD, GA)
– 07/01/97
PM 20-19-01: Providers
– 03/01/97
PM 20-19-02: Prior Approval
– 03/01/97
PM 20-19-02-a: Artificial Limbs and Braces
– 03/01/97
PM 20-19-02-b: Standard Wheelchairs
– 03/01/97
PM 20-19-02-c: Custom Wheelchair
– 03/01/97
PM 20-19-02-d: Hearing Aids
– 03/01/97
PM 20-19-02-e: Respiratory Aids
– 03/01/97
PM 20-19-02-f: Standard Hospital Bed, Firm Mattress and/or Bed Board
– 03/01/97
PM 20-19-02-g: Special Beds, Flotation or Alternating Pressure Pads
– 03/01/97
PM 20-19-02-h: Custom Molded Shoes, Shoe Corrections, Shoe Braces
– 03/01/97
PM 20-19-02-i: Other Equipment
– 03/01/97
PM 20-19-03: Payment
– 03/01/97
PM 20-20-00: Mental Health (TANF, AABD, GA)
– 07/01/97
PM 20-20-01: Services
– 03/01/97
PM 20-20-01-a: Psychiatric Services (TANF, AABD, P3 TA, Cat. 07 GA Under Age 18)
– 07/01/97
PM 20-20-01-b: Psychological Services (TANF, AABD, P3 TA, Cat.07 GA Under Age 18)
– 07/01/97
PM 20-20-01-c: Community Mental Health Services (TANF, AABD, GA)
– 07/01/97
PM 20-20-02: Providers
– 03/01/97
PM 20-20-03: Payment
– 03/01/97
PM 20-20-04: Referrals
– 03/01/97
PM 20-21-00: Healthy Kids Program (TANF, AABD, GA)
– 07/01/97
PM 20-21-01: Providers
– 03/01/97
PM 20-21-02: Payment
– 03/01/97
PM 20-22-00: Transportation (TANF, AABD, GA)
– 06/01/01
PM 20-22-01: Providers
– 03/01/97
PM 20-22-02: Prior Approval
– 06/01/01
PM 20-22-02-a: Referral to DynTek
– 06/01/01
PM 20-22-02-b: Family Community Resource Center
– 06/01/01
PM 20-22-02-c: Central All Kids Unit
– 06/01/01
PM 20-22-02-d: Bureau of Comprehensive Health Services
– 06/01/01
PM 20-22-03: Payment
– 03/01/97
PM 20-23-00: Renal Dialysis (TANF, AABD, P3 TA, Category 07 GA under Age 18)
– 07/01/97
PM 20-23-01: Providers
– 03/01/97
PM 20-23-02: Payment
– 03/01/97
PM 20-24-00: Managed Care Organization (MCO)
– 11/07/07 MR 07.23
PM 20-24-01: Enrolling in an MCO
– 04/04/03
PM 20-24-02: Leaving an MCO
– 04/03/03
PM 20-24-03: Complaints about MCOs
– 04/03/03
PM 20-24-04: Services
– 12/01/09 MR 10.09
PM 20-24-05: Providers
– 06/01/12 MR 12.14
PM 20-24-06: Prior Approval
– 04/03/03
PM 20-24-07: Payment
– 04/03/03
PM 20-25-00: Hospice Care (TANF, AABD, GA)
– 07/01/97
PM 20-25-01: Providers
– 03/01/97
PM 20-25-02: Payment
– 03/01/97
PM 20-26-00: Alcohol/Drug Abuse Treatment (TANF, AABD, P3 TA, GA Under Age 18)
– 07/01/97
PM 20-26-01: Providers
– 03/01/97
PM 20-26-02: Payment
– 03/01/97
PM 20-26-03: Referrals
– 03/01/97
PM 20-27-00: Organ Transplants (TANF, AABD, P3 TA, Category 07 GA Under Age 18)
– 07/01/97
PM 20-27-01: Providers
– 03/01/97
PM 20-27-02: Prior Approval
– 03/01/97
PM 20-27-03: Payment
– 03/01/97
PM 20-28-00: In-home Care or Medicaid Waiver (AABD)
– 07/01/97
PM 20-28-01: Application
– 07/01/97
PM 20-28-02: Services
– 07/01/98
PM 20-28-03: Fees
– 03/01/97
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