HOME    SEARCH    ABOUT US    CONTACT US    HELP   
           
Rule: 37.86.3910 Prev     Up     Next    
Rule Title: TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, REIMBURSEMENT
Add to My Favorites
Add to Favorites
Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: MEDICAID PRIMARY CARE SERVICES
Subchapter: Targeted Case Management Services for Children with Special Health Care Needs
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

Printer Friendly Version

37.86.3910    TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, REIMBURSEMENT

(1) Targeted case management services for children and youth with special health care needs are reimbursed at the lower of the following:

(a) the provider's customary charge to the general public for the service; or

(b) the department's current fee schedule under ARM 37.85.105.

(2) The following activities may not be billed as targeted case management and are not reimbursable as a unit of targeted case management:

(a) outreach to the child or child's caregiver(s);

(b) application activities related to Medicaid services or eligibility;

(c) direct medical services, including counseling or the transportation or escort of members;

(d) duplicate payments that are made to providers under Medicaid or other program authorities;

(e) writing, recording, or entering case notes for the member's files;

(f) travel to and from member activities;

(g) coordination of the investigation of any suspected abuse, neglect, or exploitation cases; and

(h) any service less than eight minutes duration if it is the only service provided that day.

(3) Targeted case management services are not separately billable for members enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program.

(4) All targeted case management services must meet the guidelines of medical necessity set forth in ARM 37.85.410.

 

History: 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.


 

 
MAR Notices Effective From Effective To History Notes
37-768 10/14/2017 Current History: 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.
3/11/1997 10/14/2017 History: Sec. 53-6-113, MCA; IMP, Sec. 53-6-101, MCA; NEW, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481.
Home  |   Search  |   About Us  |   Contact Us  |   Help  |   Disclaimer  |   Privacy & Security