048.0037.13.8
Ch. 13, § 8. Excluded Services
Cite as Medicaid Rules, Ch. 13, § 8
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(a) The following services are excluded:
(i) Clinical services which are not provided in person or via a telehealth modality, other than collateral contacts necessary to develop or implement a treatment plan;
(ii) Education, public education, public relations, and speaking engagements;
(iii) Day care;
(iv) Driving while under the influence (DUI) classes;
(v) Missed appointments;
(vi) Psychological testing done for the sole purpose of education diagnosis, school or institution admission or placement or Medicaid waiver eligibility assessments;
(vii) Record-keeping time, unless allowed by a specific service code;
(viii) Recreation and socialization without an active clinical treatment component as specified in the individual client's treatment plan;
(ix) Remedial or other formal education;
(x) Residential room, board, or care;
(xi) Substance abuse or mental health disorder prevention services;
(xii) Support groups, such as Alcoholics Anonymous or Narcotics Anonymous;
(xiii) Time spent preparing records or reports, except for up to three (3) hours for a licensed psychologist to prepare a formal report of test findings;
(xiv) Vocational services;
(xv) Services provided to a client with:
(A) Sole Diagnostic and Statistical Manual (DSM) diagnosis of intellectual or cognitive disability;
(B) DSM diagnosis of factitious disorder; or
(C) DSM diagnosis of any ICD-10 "Z" code, unless the client's medical record contains a written statement signed by the affiliated clinical professional explaining why the treatment of a condition that is not classified as a mental disorder is medically necessary;
(xvi) Services provided by a school psychologist, except when provided pursuant to Medicaid Rules Chapter 52 School Based Services.