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UNOFFICIAL 1737-101 (C) The State has determined that the services sought are unavailable in Hawaii or more readily available in another state; or (2) Out-of-state Services shall require prior authorization by the department, with the

exception to the services indicated in subsection (b), paragraphs (1) and (2).

(b) Children under the age of nineteen and children under the age of twenty-one years who are in foster care placement or are covered by subsidized adoption agreements shall be eligible for out-of-state medical services. [Eff 02/10/97 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§430(a); 431.52)

§17-1737-84 Exclusions and limitations. (a) Medical assistance payments shall not be made for certain health services or items for reasons including, but not limited to the following: (1) The procedure, service, or material is of generally unproven benefit; (2) It is of an experimental nature; (3) It is excluded by federal regulations or state rules; (4) It is not considered by the department to be medically necessary; (5) The same or similar results may be obtained by another method at a reduced cost; (6) The procedure is frequently followed by severe complications which may be in themselves life-threatening or require prolonged medical care or secondary operations; or (7) Prior authorization is required but has not been obtained.

(b) Based on subsection (a), the following procedures or services are excluded and the medical assistance program shall not pay any services in association with them: (1) Drugs not approved by the U.S. Food and Drug Administration; (2) Long term psychiatric institutional treatment; (3) Treatment of a person confined to a public institution regardless of where the treatment is performed; (4) The follow-up examination or treatment of Hansen's disease after the diagnosis has been established regardless of whether the