Section 16.03.09.390 - SERVICES, TREATMENTS, AND PROCEDURES NOT COVERED BY MEDICAL ASSISTANCEThe following services, treatments, and procedures are not covered for payment by the Medical Assistance Program:
01.Service Categories Not Covered. The following service categories are not covered for payment by the Medical Assistance Program:b. Naturopathic services;d. Group hydrotherapy; ande. Fertility-related services, including testing.02.Types of Treatments and Procedures Not Covered. The costs of physician and hospital services for the following types of treatments and procedures are not covered for payment by the Medical Assistance Program: 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;b. Cosmetic surgery, excluding reconstructive surgery that has prior approval by the Department;f. Procedures and testing for the inducement of fertility. This includes artificial inseminations, consultations, counseling, office exams, tuboplasties, and vasovasostomies;g. 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;h. Drugs supplied to patients for self-administration other than those allowed under the conditions of Section 662 of these rules;i. Services provided by psychologists and social workers who are employees or contract agents of a physician, or a physician's group practice association except for psychological testing on the order of the physician;j. The treatment of complications, consequences, or repair of any medical procedure where the original procedure was not covered by the Medical Assistance Program, unless the resultant condition is life-threatening as determined by the Department;k. Medical transportation costs incurred for travel to medical facilities for the purpose of receiving a noncovered medical service;l. Eye exercise therapy; orm. Surgical procedures on the cornea for myopia.03.Experimental Treatments or Procedures. Treatments and procedures used solely to gain further evidence or knowledge or to test the usefulness of a drug or type of therapy are not covered for payment by the Medical Assistance Program. This includes both the treatment or procedure itself, and the costs for all follow-up medical treatment directly associated with such a procedure. Treatments and procedures deemed experimental are not covered for payment by the Medical Assistance Program under the following circumstances: a. The treatment or procedure is in Phase I clinical trials in which the study drug or treatment is given to a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects;b. There is inadequate available clinical or pre-clinical data to provide a reasonable expectation that the trial treatment or procedure will be at least as effective as non-investigational therapy; orc. Expert opinion suggests that additional information is needed to assess the safety or efficacy of the proposed treatment or procedure.Idaho Admin. Code r. 16.03.09.390