HAR §17-1746-16. Excluded services

The following services shall not be paid for under the capitated rate: (1) Inpatient hospital care provided under Medicaid; (2) Ambulance or emergency transportation or both as provided under Medicaid; (3) Laboratory and X-rays, including tests ordered as part of the routine care, physical examinations or preventive care, physical examinations or preventive care provided by the PACE provider; (4) Medical specialists; (5) Home health services provided under Medicaid; (6) Any services which have not been authorized by the multidisciplinary team, even if the service is listed as a covered benefit; 1746-7 §17-1746-19 (7) Services rendered in a non-emergency setting or for a non-emergency reason without the PACE provider authorization; (8) Prescription drugs not prescribed by the PACE provider; (9) Cosmetic surgery unless required for improved functioning of a malformed part of the body resulting from an accidental injury or for reconstruction following mastectomy; (10) Experimental, medical, surgical, or other health procedures not generally available in the Hawaii area; (11) Gender alteration procedures; (12) Family planning; (13) Maternal care and pediatrics; (14) Service in any hospital for the treatment of tuberculosis or chronic medically uncomplicated drug dependency or alcoholism; and (15) Any services rendered outside of the United States. [Eff 01/29/96 ] (Auth: SLH 1992, Act 211; HRS §346-59) (Imp: HRS §346-14; 42 C.F.R. §434.20)