(a) The Medically Indigent Program shall cover only the following medically necessary in-patient services: (1) maximum of sixty (60) days inpatient hospitalization per illness. If confinement is medically necessary after the sixty (60) days, prior authorization is required from MIP; (2) semi-private room and board, or private room when medically necessary; (3) coronary and intensive care; (4) neonatal intensive care, intermediate nursery care and wellborn nursery care; (5) surgery and anesthesia; (6) operating room, delivery room and licensed birthing center services; (7) diagnostic laboratory services; (8) diagnostic radiology, ultrasound and mammography screening services; (9) renal dialysis treatment;
COL 2025-12-23
(10) physician services; (11) emergency room services; (12) acute physical and occupational therapy when prescribed by physician and provided by a qualified licensed and registered therapist, subject to limitations stated below; (13) respiratory therapy; (14) prescribed drugs in accordance with the established MIP formulary; (15) podiatry services; care in an intermediate care facility; and ambulance services. (b) In-Patient Services Not Covered. The Medically Indigent Program shall not cover the following in-patient services: (1) elective cosmetic surgery, except as provided for in the Women’s Health Act; (2) custodial care, domiciliary care, private duty nursing or rest cures, except as provided for in hospices; (3) personal comfort or convenience items; (4) any diagnostic service requiring prior authorization which has not been obtained or has been denied; (5) any specialized elective surgical service requiring prior authorization, which has not been obtained or has been denied; or (6) non-emergency use of the Emergency Room. (c) Limitations and Exclusions. All in-patient services are subject to the stated benefit limitations and exclusions outlined in § 2912 through § 2913. SOURCE: Added by P.L. 25-163:2 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2003).