Services, Treatments, And Procedures Not Covered By Medicaid

01. Service Categories Not Covered. The following service categories are not covered for payment by Medicaid except as otherwise specified: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 060 Page 39 a. Acupuncture services; (7-1-26) b. Naturopathic services; (7-1-26) c. Bio-feedback therapy; (7-1-26) d. Group hydrotherapy; (7-1-26) e. Fertility-related services, including testing; (7-1-26) f. Vocational services except for supported employment services; (7-1-26) g. Educational services; (7-1-26) h. Recreational services; (7-1-26) i. Duplicative services; (7-1-26) j. Housing except when approved for a medical institution; and (7-1-26) k. Food, except when medically necessary or the home-delivered meals benefit. (7-1-26) 02. Types of Treatments and Procedures Not Covered. The costs of provider and hospital services for the following types of treatments and procedures are not covered for payment by Medicaid: (7-1-26) a. Elective medical and surgical treatment, except for family planning services, without Departmental approval. Procedures that are generally accepted by the medical community and are medically necessary may not require prior approval and may be eligible for payment; (7-1-26) b. Services for convenience, comfort, or cosmetic reasons except when allowed elsewhere in rule. Hospice services, and reconstructive surgery that has prior approval by the Department are covered benefits;(7-1-26) c. Laetrile therapy; (7-1-26) d. New procedures of unproven value and established procedures of questionable current usefulness as identified by the Public Health Service and that are excluded by the Medicare program or major commercial carriers; (7-1-26) e. Drugs supplied to patients for self-administration other than those allowed under these rules; (7-1-26) f. The treatment of complications, consequences, or repair of any medical procedure where the original procedure was not covered by Medicaid, unless the resultant condition is life-threatening as determined by the Department; (7-1-26) g. Medical transportation costs incurred for travel to medical facilities for the purpose of receiving a noncovered medical service; (7-1-26) h. Surgical procedures on the cornea for myopia; or (7-1-26) i. Services as detailed in Section 56-273, Idaho Code. (7-1-26) 03. Experimental Treatments or Procedures. Experimental treatments and procedures, and the costs for all follow-up medical treatment directly associated with such a procedure are not covered. Treatments and procedures are deemed experimental under the following circumstances: (7-1-26) a. The treatment or procedure is in Phase I clinical trials; (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 061 Page 40 b. There is inadequate available clinical data to provide a reasonable expectation that the trial treatment or procedure will be at least as effective as non-investigational therapy; or (7-1-26) c. Expert opinion suggests that additional information is needed to assess the safety or efficacy of the proposed treatment or procedure. (7-1-26)