Section 16.03.09.399 - COVERED SERVICES UNDER BASIC PLAN BENEFITSIndividuals who are eligible for Medicaid Basic Plan Benefits are eligible for the following benefits, subject to the coverage limitations contained in these rules. Those individuals eligible for services under IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits," are also eligible for the services covered under this chapter of rules, unless specifically exempted.
01.Hospital Services. The range of hospital services covered is described in Sections 400 through 449 of these rules.a. Inpatient and outpatient Hospital Services are described in Sections 400 through 416.b. Reconstructive Surgery services are described in Sections 420 through 426.c. Surgical procedures for weight loss are described in Sections 430 through 436.d. Investigational procedures or treatments are described in Sections 440 through 446.02.Ambulatory Surgical Centers. Ambulatory Surgical Center services are described in Sections 450 through 499 of these rules.03.Physician Services and Abortion Procedures. Physician services and abortion procedures are described in Sections 500 through 519 of these rules. a. Physician services are described in Sections 500 through 506.b. Abortion procedures are described in Sections 510 through 516.04.Other Practitioner Services. Other practitioner services are described in Sections 520 through 559 of these rules.a. Non-physician practitioner services are described in Sections 520 through 526.b. Chiropractic services are described in Sections 530 through 536.c. Podiatrist services are described in Sections 540 through 545.d. Licensed midwife (LM) services are described in Sections 546 through 552.e. Optometrist services are described in Sections 553 through 556.05.Primary Care Case Management. Primary care case management services are described in Sections 560 through 579 of these rules.a. Healthy Connections services are described in Sections 560 through 566.06.Prevention Services. The range of prevention services covered is described in Sections 570 through 649 of these rules.a. Children's habilitation intervention services are described in Sections 570 through 577.b. Child Wellness Services are described in Sections 580 through 584.c. Adult Physical Services are described in Sections 590 through 596.d. Screening mammography services are described in Sections 600 through 606.e. Diagnostic Screening Clinic services are described in Sections 610 through 614.f. Additional Assessment and Evaluation services are described in Section 615.g. Health Questionnaire Assessment is described in Section 618.h. Preventive Health Assistance benefits are described in Sections 620 through 626.i. Nutritional services are described in Sections 630 through 636.j. Diabetes Education and Training services are described in Sections 640 through 646.07.Laboratory and Radiology Services. Laboratory and radiology services are described in Sections 650 through 659 of these rules.08.Prescription Drugs. Prescription drug services are described in Sections 660 through 679 of these rules.09.Family Planning. Family planning services are described in Sections 680 through 689 of these rules.10.Outpatient Behavioral Health Services. Community-based outpatient services for behavioral health treatment are described in Sections 707 through 711 of these rules.11.Inpatient Psychiatric Hospital Services. Inpatient Psychiatric Hospital services are described in Sections 700 through 706.12.Home Health Services. Home health services are described in Sections 720 through 729 of these rules.13.Therapy Services. Occupational therapy, physical therapy, and speech-language pathology services are described in Sections 730 through 739 of these rules.14.Audiology Services. Audiology services are described in Sections 740 through 749 of these rules.15.Durable Medical Equipment and Supplies. The range of covered durable medical equipment and supplies is described in Sections 750 through 779 of these rules. a. Durable Medical Equipment and supplies are described in Sections 750 through 756.b. Prosthetic and orthotic services are described in Sections 770 through 776.16.Vision Services. Vision services are described in Sections 780 through 789 of these rules.17.Dental Services. Medicaid dental services are covered under a selective contract as described in Section 800 through 819 of these rules.18.Essential Providers. The range of covered essential services is described in Sections 820 through 859 of these rules. a. Rural health clinic services are described in Sections 820 through 826.b. Federally Qualified Health Center services are described in Sections 830 through 836.c. Indian Health Services Clinic services are described in Sections 840 through 846.d. School-Based services are described in Sections 850 through 857.19.Transportation. The range of covered transportation services is described in Sections 860 through 879 of these rules.a. Emergency transportation services are described in Sections 860 through 866.b. Non-emergency medical transportation services are described in Sections 870 through 876.20.EPSDT Services. EPSDT services are described in Sections 880 through 889 of these rules.21.Specific Pregnancy-Related Services. Specific pregnancy-related services are described in Sections 890 through 899 of these rules.Idaho Admin. Code r. 16.03.09.399