PM 20: Medical Program

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 – 04/22/14 MR 14.12
- PM 20-02-02: People in Jail – 07/16/12 MR 12.19
- PM 20-02-03 Automated Medical Benefit Restriction for Incarcerated Individuals – 03/23/17 MR #17.07
PM 20-03-00 Department Responsibilities (AABD, TANF) – 07/01/13 MR 13.16
- 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: Customer Copays – 01/18/2024 MR #24.01
  - 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) – 07/01/13 MR 13.16
- 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 – 02/06/14 MR 14.05
  - 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) – 07/01/13 MR 13.16
- 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) – 04/22/14 MR 14.12
- PM 20-06-01: Providers – 07/01/13 MR 13.16
- PM 20-06-02: Payment – 03/01/97
PM 20-07-00: Physicians (TANF, AABD) – 07/01/13 MR 13.16
- PM 20-07-01: Providers – 07/01/13 MR 13.16
- PM 20-07-02: Payment – 03/01/97
PM 20-08-00: Long Term Care/Supportive Living (AABD,TANF) – 07/01/13 MR 13.16
- 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 For Individuals with Intellectual Disabilities(ICF/IID) – 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 – 02/06/14 MR 14.05
  - 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 – 02/06/14 MR 14.05
  - 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) – 07/01/13 MR 13.16
- PM 20-09-01: Providers – 07/01/13 MR 13.16
- PM 20-09-02: Payment – 07/01/13 MR 13.16
PM 20-10-00: Physical Rehabilitation (TANF, AABD) – 04/22/14 MR 14.12
- 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) – 07/01/13 MR 13.16
- PM 20-12-01: Home Health Care (TANF, AABD) – 07/01/13 MR 13.16
  - 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: Reserve – 07/01/13 MR 13.16
PM 20-13-00: Eye Care (TANF, AABD) – 07/01/13 MR 13.16
- 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) – 07/01/13 MR 13.16
- 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) – 07/01/13 MR 13.16
- 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) – 07/01/13 MR 13.16
- 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) – 07/01/13 MR 13.16
- PM 20-17-01: Providers – 03/01/97
- PM 20-17-02: Payment – 07/01/13 MR 13.16
PM 20-18-00: Drugs, Medical Supplies, and Sickroom Needs (TANF, AABD) – 07/01/13 MR 13.16
- 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 – 03/21/14 MR 14.10
PM 20-19-00: Medical Equipment and Prosthetic Devices (TANF, AABD) – 07/01/13 MR 13.16
- 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 – 07/01/13 MR 13.16
PM 20-20-00: Mental Health (TANF, AABD) – 07/01/13 MR 13.16
- PM 20-20-01: Services – 03/01/97
  - PM 20-20-01-a: Psychiatric Services (TANF, AABD) – 07/01/13 MR 13.15
  - PM 20-20-01-b: Psychological Services (TANF, AABD) – 07/01/13 MR 13.16
  - PM 20-20-01-c: Community Mental Health Services (TANF, AABD) – 07/01/13 MR 13.16
- 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) – 07/01/13 MR 13.16
- PM 20-21-01: Providers – 03/01/97
- PM 20-21-02: Payment – 03/01/97
PM 20-22-00: Transportation (TANF, AABD, GA) – 07/01/13 MR 13.16
- 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 – 04/02/18 MR #18.07
  - 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) – 07/01/13 MR 13.16
- PM 20-23-01: Providers – 03/01/97
- PM 20-23-02: Payment – 03/01/97
PM 20-24-00: Managed Care Organization (MCO) – 01/24/2024 MR #24.03
- PM 20-24-01: Enrolling in an MCO – 01/24/2024 MR #24.03
- PM 20-24-02: Leaving a MCO – 01/24/2024 MR #24.03
- PM 20-24-03: Complaints about MCOs – 01/24/2024 MR #24.03
- PM 20-24-04: MCO Services – 01/24/2024 MR #24.03
- PM 20-24-05: MCO Provider Assignment/Enrollment – 01/24/2024 MR #24.03
- PM 20-24-06: MCO - Prior Approval – 01/24/2024 MR #24.03
- PM 20-24-07: MCO - Payment – 01/24/2024 MR #24.03
PM 20-25-00: Hospice Care (TANF, AABD) – 07/01/13 MR 13.16
- PM 20-25-01: Providers – 03/01/97
- PM 20-25-02: Payment – 07/01/13 MR 13.16
PM 20-26-00: Alcohol/Drug Abuse Treatment (TANF, AABD) – 07/01/13 MR 13.16
- 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) – 07/01/13 MR 13.16
- 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