10 GCA § 2907.1: In-Patient Services.

(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;

(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.