Montana Administrative Code

37.40.106 INTERMEDIATE NURSING CARE Intermediate care services may be included in facilities licensed as a skilled nursing home or a personal care home which has a registered or a licensed practical nurse on duty eight hours a day, seven days a week, and with adequate personnel t…

37.40.110 SERVICES FURNISHED The following sections list those services commonly furnished by nursing personnel in skilled nursing homes and their usual skill classification. Any generally non-skilled service could, because of special medical complications in an individual case, …

37.40.1101 PERSONAL CARE SERVICES, SERVICES PROVIDED AND LIMITATIONS (REPEALED) Authorizing statute(s): 53-6-113, 53-6-201, MCA Implementing statute(s): 53-6-101, 53-6-131, 53-6-141, MCA History: NEW, 1980 MAR p. 1105, Eff. 3/28/80; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1987 M…

37.40.1102 PERSONAL CARE SERVICES, REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-6-101, 53-6-131, 53-6-141, MCA History: NEW, 1980 MAR p. 1105, Eff. 3/28/80; AMD, 1980 MAR p. 2979, Eff. 11/29/80; AMD, 1983 MAR p. 863, Eff. 7/1…

37.40.1105 PERSONAL CARE SERVICES, AGENCY-BASED REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA Implementing statute(s): 53-6-101, 53-6-141, MCA History: NEW, 1980 MAR p. 1105, Eff. 3/28/80; AMD, 1980 MAR p. 2979, Eff. 11/29/80; AMD, 1981 MAR p.…

37.40.1106 PERSONAL CARE SERVICES, PROVIDER COMPLIANCE (REPEALED) Authorizing statute(s): 53-6-101, 53-6-113, 53-2-201, MCA Implementing statute(s): 53-6-101, 53-6-113, MCA History: NEW, 1995 MAR p. 1191, Eff. 7/1/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; REP, 20…

37.40.1110 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: DEFINITIONS "Activities of daily living" (ADL) means basic personal everyday activities limited to bathing, personal hygiene, transferring, positioning, eating, dressing, toileting, assistance with exercise r…

37.40.1111 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: ELIGIBILITY, SERVICES PROVIDED, AND LIMITATIONS To qualify for Personal Assistance Services (PAS), a person must: be Medicaid eligible; and demonstrate a medical and functional need for assistance with activi…

37.40.1114 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PERSON-CENTERED PLAN REQUIREMENTS In order to receive Personal Assistance Services (PAS), the member must be capable of making choices about activities of daily living and instrumental activities of daily liv…

37.40.1115 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: DESCRIPTION AND PURPOSE Self-directed Personal Assistance Services (PAS) are services provided to Medicaid members who choose to take the responsibility or have a representative take the responsibility of managing the PAS. Se…

37.40.1116 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: GENERAL REQUIREMENTS Self-directed Personal Assistance Services (PAS) may only be delivered by an attendant who is the employee of a Medicaid-enrolled provider and who is selected by the member or their personal representativ…

37.40.1117 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: MEMBER REQUIREMENTS To qualify for self-directed Personal Assistance Services (PAS), the member: must be capable of assuming the management responsibilities of self-directed PAS or have a personal representative willing to as…

37.40.1121 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: TERMINATION OF SERVICES Personal Assistance Services (PAS) may be terminated for any of the following reasons: the member, or other persons in the household, subjects the direct-care worker to physical or ver…

37.40.1122 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PROVIDER ENROLLMENT Providers will enroll as a Personal Assistance Services (PAS) personal care attendant provider. Providers must enroll through the department's fiscal intermediary. PAS providers must be bu…

37.40.1125 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: CONFLICT-OF-INTEREST CRITERIA In order to perform the duties of an agency-based nurse supervisor, self-directed program oversight staff, or the Personal Assistance Services (PAS) provider person-centered plan…

37.40.1126 AGENCY-BASED PERSONAL ASSISTANCE SERVICES: PROVIDER REQUIREMENTS Providers may enroll as a Personal Assistance Services (PAS) personal care attendant provider. PAS providers will maintain staff resources, including a nurse supervisor and person-centered plan facilitato…

37.40.1127 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PROVIDER REQUIREMENTS Self-directed Personal Assistance Services (PAS) providers must employ program oversight staff to perform the following self-directed oversight activities: assist members to identify resources for person…

37.40.1131 AGENCY-BASED PERSONAL ASSISTANCE SERVICES: PROVIDER COMPLIANCE Providers of Personal Assistance Services (PAS) will be subject to compliance reviews to provide assurance to the department that services are being provided within the rules and policy of the program. The …

37.40.1132 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PROVIDER COMPLIANCE Providers of self-directed Personal Assistance Services (PAS) will be subject to compliance reviews to provide assurance to the department that services are being provided within the rules and policy of th…

37.40.1135 AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: REIMBURSEMENT Personal Assistance Services (PAS) may be provided up to, but not more than, 80 hours of attendant service per two-week time period per person as defined by the service profile. The department m…

37.40.120 PROBLEM CASES There are some situations in which a patient's condition requires the institutional services provided by a skilled care facility, but does not require the type of care which is defined as skilled care. Such situations often arise where a patient needs exte…

37.40.1301 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, DESCRIPTION AND PURPOSE (REPEALED) Authorizing statute(s): 53-6-113, 53-6-145, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 489; REP, 2014 MA…

37.40.1302 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, APPLICATION OF GENERAL PERSONAL CARE RULES (REPEALED) Authorizing statute(s): 53-6-113, 53-6-145, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p…

37.40.1303 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-6-113, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 2011 MAR p. 1386, Eff. 7/29/11; AMD, 2013 MAR p. 1111, Eff. 7/1/13; REP, 2014 MAR p. 3086, Eff. 12/…

37.40.1305 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, CONSUMER REQUIREMENTS (REPEALED) Authorizing statute(s): 53-6-113, 53-6-145, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 489; REP, 2014 MAR …

37.40.1306 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, PLAN OF CARE REQUIREMENTS (REPEALED) Authorizing statute(s): 53-6-113, 53-6-145, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 489; REP, 2014 …

37.40.1307 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, PROVIDER REQUIREMENTS (REPEALED) Authorizing statute(s): 53-6-113, 53-6-145, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 489; REP, 2014 MAR …

37.40.1308 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, GENERAL REQUIREMENTS (REPEALED) Authorizing statute(s): 53-6-113, 53-6-145, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS, from SRS, 2000 MAR p. 489; REP, 2014 MAR p…

37.40.1315 SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, COMPLIANCE REVIEWS (REPEALED) Authorizing statute(s): 53-6-113, 53-6-145, MCA Implementing statute(s): 53-6-101, 53-6-145, MCA History: NEW, 1995 MAR p. 2823, Eff. 12/22/95; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/…

37.40.1401 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS AUTHORITY AND SCOPE OF PROGRAM The United States department of health and human services (HHS) has granted the department, through 42 CFR 441.300 through 441.310, the authority to establish a…

37.40.1402 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSON: DEFINITIONS "Adult residential care" means a residential habilitation option for consumers residing in an adult foster home, group home, or assisted living facility. "Case management" means a…

37.40.1406 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SERVICES The services available through the program are limited to those specified in this rule. The department may determine the particular services of the program to make available to a re…

37.40.1407 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: GENERAL REQUIREMENTS Services of the program may only be provided by a provider that is enrolled with the department as a Medicaid provider or, in rare instances, through a provider with who…

37.40.1408 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: ENROLLMENT A person in order to be considered by the department for enrollment in the program, must be determined by the department to qualify for enrollment in accordance with the criteria …

37.40.1409 HOME AND COMMUNITY BASED SERVICES FOR ELDERLY AND DISABLED PERSONS: QUALITY ASSURANCE REVIEWS As used in this rule, the term "provider" means case management teams, independence advisors, and financial managers. The department will conduct comprehensive provider evalua…

37.40.1415 HOME AND COMMUNITY BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: REIMBURSEMENT Services available through the program are reimbursed as specified in this rule. The following services are reimbursed as provided in (3): adult day health; adult residential c…

37.40.1420 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SERVICE PLANS A service plan is a written plan of supports and interventions based on an assessment of the status and needs of a consumer. The service plan describes the needs of the consume…

37.40.1421 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: COST OF SERVICE PLAN In order to maintain the program cost within the appropriated monies, the cost of service plans may be limited by the department collectively and individually. The total…

37.40.1422 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: COMMUNITY TRANSITION SERVICES, REQUIREMENTS Community transition services is defined in ARM 37.40.1402. Allowable expenses are those necessary to enable a person to establish a basic househo…

37.40.1423 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: FINANCIAL MANAGEMENT, REQUIREMENTS Financial management (FM) service is defined in ARM 37.40.1402. The financial manager acts as the common law employer (employer of record) and the consumer…

37.40.1424 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: INDEPENDENCE ADVISOR, REQUIREMENTS Independence advisor (IA) is defined in ARM 37.40.1402. The IA may help consumers or their personal representatives: learn how to successfully direct servi…

37.40.1425 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: CONSUMER-DIRECTED GOODS AND SERVICES, REQUIREMENTS Consumer directed goods and services is defined in ARM 37.40.1402. These items could include the purchase of appliances and vans, with or w…

37.40.1426 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: NOTICE AND FAIR HEARING The department provides written notice to an applicant for a consumer of services when a determination is made by the department concerning: financial eligibility; le…

37.40.1427 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: FAMILY TRAINING AND SUPPORT, REQUIREMENTS Family training and support is defined in ARM 37.40.1402. Services include: general orientation about the child's disability; and training specific …

37.40.1428 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: PAIN AND SYMPTOM MANAGEMENT, REQUIREMENTS Pain and symptom management is defined in ARM 37.40.1402. Treatments include but are not limited to: acupuncture; reflexology; massage therapy; cran…

37.40.1430 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: CASE MANAGEMENT, REQUIREMENTS Case management is the planning for, arranging for, implementation of and monitoring of the delivery of services available through the program to a consumer. Ca…

37.40.1431 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: HOMEMAKER CHORE, REQUIREMENTS Homemaker chore services is defined in ARM 37.40.1402. Services include: extensive cleaning beyond the scope of general household cleaning; and heavy cleaning s…

37.40.1435 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: ADULT RESIDENTIAL CARE, REQUIREMENTS Adult residential care services consist of the following categories: level 1 services, level 2 services, level 3 services, and group home services. Level…

37.40.1436 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: COMMUNITY SUPPORTS SERVICES, REQUIREMENTS (REPEALED) (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-…

37.40.1437 HOME AND COMMUNITY-BASED SERVICES TREATMENT FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: COMMUNITY RESIDENTIAL REHABILITATION, REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2000 MA…