Sec. 10.09.29.05. Limitations

The Program does not cover the following:

A. Services not specified in Regulation .04 of this chapter;

B. Services not medically necessary;

C. Investigational and experimental drugs and procedures;

D. A day of inpatient care solely for the purpose of performing diagnostic tests that can be performed on an outpatient basis;

E. Admissions with a primary diagnosis of alcoholism, drug addiction, or severe brain damage, or the following diagnoses in the ICD-9-CM,

(1) 294.0-Amnestic syndrome,

(2) 294.8-Other specified organic brain syndromes (chronic),

(3) 294.9-Unspecified organic brain syndromes (chronic),

(4) 299.00-299.8-Psychoses with origin specific to childhood,

(5) 301.7-Antisocial personality disorder,

(6) 302.70-302.79-Psychosexual dysfunction,

(7) 306.0-306.9-Physiological malfunction arising from mental factor,

(8) 307.0-Special symptoms or syndromes, not elsewhere classified (NEC),

(9) 307.2 -Tics,

(10) 307.40-307.49-Specific disorders of sleep of nonorganic origin,

(11) 307.9-Other and unspecified special symptoms or syndromes (NEC), or

(12) 316-Psychic factors associated with disease classified elsewhere;

F. Days of care for recipients remaining in the residential treatment center beyond the length of stay certified by the team which develops the individual plan of care;

G. Psychiatric services to recipients over 21 years old except as specified in Regulation .01B(16) of this chapter.