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Rule Chapter: 37.79
Chapter Title: HEALTHY MONTANA KIDS (HMK)
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37.79 : HEALTHY MONTANA KIDS (HMK)


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Rule No. Rule Title Latest
Version
Effective
Date
Subchapter 1
General Provisions
37.79.101 HEALTHY MONTANA KIDS (HMK) PLAN access file 2/15/2013
37.79.102 DEFINITIONS access file 7/1/2014
37.79.106 ELECTRONIC APPLICATIONS AND SIGNATURES access file 10/1/2009
37.79.110 PROCESS FOR IDENTIFYING AND APPROVING ENROLLMENT PARTNERS access file 10/1/2009
37.79.115 ACTIVE ENROLLMENT PROCESS access file 10/1/2009
37.79.117 PRESUMPTIVE ELIGIBILITY access file 1/1/2011
37.79.120 MOVEMENT BETWEEN HMK AND HMK PLUS access file 2/15/2013
37.79.125 POINT OF ACCESS access file 10/1/2009
37.79.130 TRANSITION access file 10/1/2009
37.79.135 PROSPECTIVE PAYMENT SYSTEM FOR FEDERALLY QUALIFIED HEALTH CENTER (FQHC) REIMBURSEMENT access file 7/1/2010
37.79.140 OUTREACH EFFORTS access file 10/1/2009
Subchapter 2
Eligibility
37.79.201 ELIGIBILITY access file 2/15/2013
37.79.202 NONQUALIFYING APPLICANTS access file 10/1/2010
Rules 37.79.203 through 37.79.205 reserved
37.79.206 ELIGIBILITY REDETERMINATION, NOTICE OF CHANGES access file 2/15/2013
37.79.207 TERMINATION OF ELIGIBILITY AND GUARDIAN LIABILITY access file 2/15/2013
37.79.208 PROVISIONAL BENEFITS, DETERMINATION OF ELIGIBILITY, AND APPLICATIONS FOR HMK access file 10/1/2009
37.79.209 ELIGIBILITY VERIFICATION REVIEWS REP 10/1/2009
Subchapter 3
Benefits
37.79.301 COVERED BENEFITS REP 2/15/2013
37.79.302 COVERAGE LIMITATIONS access file 10/1/2010
37.79.303 BENEFITS NOT COVERED REP 2/15/2013
37.79.304 SERVICES COVERED access file 7/1/2014
Rules 37.79.305 and 37.79.306 reserved
37.79.307 INPATIENT HOSPITAL BENEFITS REP 2/15/2013
37.79.308 OUTPATIENT HOSPITAL BENEFITS REP 2/15/2013
37.79.309 PHYSICIAN AND ADVANCED PRACTICE REGISTERED NURSE BENEFITS, LIMITATIONS, AND EXCLUSIONS REP 2/15/2013
Rules 37.79.310 and 37.79.311 reserved
37.79.312 PRESCRIPTION DRUG BENEFITS REP 2/15/2013
37.79.313 LABORATORY AND RADIOLOGY BENEFITS REP 2/15/2013
Rules 37.79.314 and 37.79.315 reserved
37.79.316 MENTAL HEALTH BENEFITS REP 2/15/2013
37.79.317 SUBSTANCE USE DISORDER BENEFITS REP 2/15/2013
Rules 37.79.318 through 37.79.320 reserved
37.79.321 VISION BENEFITS access file 2/13/2004
37.79.322 EYEGLASS BENEFITS access file 2/13/2004
Rules 37.79.323 and 37.79.324 reserved
37.79.325 AUDIOLOGY BENEFITS REP 2/15/2013
37.79.326 DENTAL BENEFITS access file 7/1/2014
Subchapter 4
reserved
Subchapter 5
Enrollment Provisions
37.79.501 COST SHARING PROVISIONS access file 10/1/2013
Rule 37.79.502 reserved
37.79.503 ENROLLMENT access file 2/15/2013
37.79.504 RIGHT TO CHOOSE PRIMARY CARE PROVIDER REP 1/18/2008
37.79.505 DISENROLLMENT access file 2/15/2013
Subchapter 6
Services and Provider Requirements
37.79.601 CONTRACT FOR SERVICES access file 10/1/2009
37.79.602 PROVISION OF BENEFITS access file 2/15/2013
Rules 37.79.603 and 37.79.604 reserved
37.79.605 PARTICIPATING PROVIDERS access file 10/1/2009
37.79.606 REIMBURSEMENT OF THIRD PARTY ADMINISTRATOR access file 1/18/2008
37.79.607 UTILIZATION REVIEW AND QUALITY ASSURANCE access file 1/18/2008
Subchapter 7
reserved
Subchapter 8
Hearing and Appeal Procedures
37.79.801 GRIEVANCE AND APPEAL PROCEDURES access file 2/15/2013
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