Montana Administrative Code

37.40.1438 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SUPPORTED LIVING, REQUIREMENTS (REPEALED) (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2000 MAR p. 2023, Eff. 7/2…

37.40.1439 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SENIOR COMPANION SERVICES, REQUIREMENTS Senior companion services is defined in ARM 37.40.1402. The service includes: respite; socialization; supervision; and homemaking. Providers of this s…

37.40.1440 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: PARTICIPATION DIRECTION Participant direction is defined in ARM 37.40.1402. Services may be directed by: an adult who has the capacity to self-direct; a legal representative of the member, i…

37.40.1441 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: HEALTH AND WELLNESS, REQUIREMENTS Health and wellness services is defined in ARM 37.40.1402. The service includes adaptive health, wellness, and therapeutic recreational services such as: hi…

37.40.1445 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: ADULT DAY HEALTH Adult day health is the provision of services to meet the health, social and habilitation needs of a recipient in settings outside the recipient's place of residence. An ent…

37.40.1446 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: POST-ACUTE REHABILITATION SERVICES, REQUIREMENTS Post-acute rehabilitation is the provision of therapeutic intervention to a consumer with brain injury or other related disability in a resid…

37.40.1447 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: PERSONAL ASSISTANCE, REQUIREMENTS Personal assistance is the provision of an array of personal care and other services to a recipient for the purpose of meeting personal needs in the home an…

37.40.1448 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: HABILITATION, REQUIREMENTS Habilitation is the provision of intervention services designed for assisting a consumer to acquire, retain, and improve the self-help, socialization, and adaptive…

37.40.1449 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SPECIALLY TRAINED ATTENDANT CARE, REQUIREMENTS Specially trained attendant care is an option under personal assistance that provides supportive services to a consumer residing in their own r…

37.40.1450 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: HOMEMAKING, REQUIREMENTS Homemaking is the provision of general household activities or chore services to a recipient when the recipient is unable to manage the recipient's home or care for …

37.40.1451 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: RESPITE CARE, REQUIREMENTS Respite care is the provision of supportive care to a consumer so as to relieve those unpaid persons normally caring for the consumer from that responsibility. Res…

37.40.1452 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SPECIALIZED CHILD CARE FOR MEDICALLY FRAGILE CHILDREN, REQUIREMENTS Specialized child care for medically fragile children is the provision of day care, respite care, and other direct and sup…

37.40.1460 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: OUTPATIENT OCCUPATIONAL THERAPY, REQUIREMENTS Outpatient occupational therapy services may include: occupational therapy services as specified at ARM 37.86.601; and services for habilitative…

37.40.1461 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: OUTPATIENT PHYSICAL THERAPY, REQUIREMENTS Outpatient physical therapy services may include: physical therapy services as specified at ARM 37.86.601; and services for habilitative or maintena…

37.40.1462 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SPEECH PATHOLOGY AND AUDIOLOGY, REQUIREMENTS Speech pathology and audiology services may include: speech therapy services as defined at ARM 37.86.601; audiology services as defined at ARM 37…

37.40.1463 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: RESPIRATORY THERAPY, REQUIREMENTS Respiratory therapy is the provision of direct respiratory treatment, ongoing assessment of respiratory and medical conditions, equipment monitoring and upk…

37.40.1464 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: PSYCHO-SOCIAL CONSULTATION, REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-141, 53-6-402, MCA H…

37.40.1465 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: CONSULTATIVE CLINICAL AND THERAPEUTIC SERVICES, REQUIREMENTS These are services that assist unpaid and/or paid caregivers in carrying out individual service plans and are necessary to improv…

37.40.1466 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: CHEMICAL DEPENDENCY COUNSELING, 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 MAR p. 2023, Eff. …

37.40.1467 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: COGNITIVE 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 MAR p. 2023, Eff. 7/28/0…

37.40.1475 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: DIETETIC SERVICES, REQUIREMENTS Dietetic services are the management of a person's nutritional needs. Dietetic services may include evaluation and monitoring of nutritional status, nutrition…

37.40.1476 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: NUTRITION, REQUIREMENTS Nutrition services are meals, congregate meals and home delivered meals as specified at ARM 37.41.302 including the meals on wheels program. The requirements for the …

37.40.1477 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: NURSING, REQUIREMENTS Nursing is the provision of individual and continuous nursing care. Authorizing statute(s): Sec. 53-2-201, 53-6-101, 53-6-113 and 53-6-402, MCA Implementing statute(s):…

37.40.1485 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: ENVIRONMENTAL ACCESSIBILITY ADAPTATION, REQUIREMENTS Environmental accessibility adaptations are modifications to a member's home, designed to maintain or improve the member's ability to rem…

37.40.1486 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: PERSONAL EMERGENCY RESPONSE SYSTEMS, REQUIREMENTS A personal emergency response system is an electronic device or mechanical system used to summon assistance in an emergency situation. A per…

37.40.1487 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES, REQUIREMENTS Specialized medical equipment and supplies is the provision of items of medical equipment and supplies to a recipient for the purpose…

37.40.1488 HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: NONMEDICAL TRANSPORTATION, REQUIREMENTS Nonmedical transportation is the provision to a consumer of transportation through common carrier or private vehicle for access to social or other non…

37.40.1501 PEDIATRIC COMPLEX CARE ASSISTANT SERVICES, REQUIREMENTS To qualify for Pediatric Complex Care Assistant (PCCA) services, an individual must be a Medicaid member under 21 years of age. PCCA services must be provided in accordance with the requirements of 37-2-603, MCA. …

37.40.1502 PEDIATRIC COMPLEX CARE ASSISTANT SERVICES, PROVIDER REQUIREMENTS AND ENROLLMENT Pediatric Complex Care Assistant (PCCA) service provider agencies must be enrolled Medicaid providers. PCCA service provider agencies must be a business entity formed or registered to do bu…

37.40.1503 PEDIATRIC COMPLEX CARE ASSISTANT SERVICES, REIMBURSEMENT Pediatric Complex Care Assistant (PCCA) services may not exceed 24 hours, or 96 units, in a single day for an individual. The rate for PCCA services is the lesser of: $10.78 per 15-minute unit of service, which e…

37.40.201 PREADMISSION SCREENING, DEFINITIONS "Active treatment" means: for persons with mental retardation or a related condition, a continuous program which includes aggressive consistent implementation of a program of specialized and generic training, treatment, health service…

37.40.202 PREADMISSION SCREENING, GENERAL REQUIREMENTS This rule provides the preadmission screening requirements of the Montana medicaid program for applicants to nursing facilities participating in the Montana medicaid program. Nursing facility applicants must undergo a level I…

37.40.205 PREADMISSION SCREENING, NURSING FACILITY SERVICES For elderly persons and physically disabled persons, the need for nursing facility service will be determined based upon the following criteria: The services of a skilled nursing facility (SNF) are needed when a person m…

37.40.206 PREADMISSION SCREENING, REDETERMINATION OF NEED FOR NURSING FACILITY SERVICES For a person who is identified as in need of nursing facility services, and is enrolled in the home and community services program, a redetermination of the need for nursing facility services …

37.40.207 PREADMISSION SCREENING, QUALIFIED MENTAL RETARDATION PROFESSIONAL The department will approve persons as qualified mental retardation professionals for purposes of providing preadmission screening and medicaid related case management services. Qualified mental retardati…

37.40.301 SCOPE, APPLICABILITY, AND PURPOSE This subchapter specifies requirements applicable to provision of and reimbursement for Medicaid nursing facility services, including intermediate care facility services for individuals with intellectual disabilities. These rules are in…

37.40.302 DEFINITIONS Unless the context requires otherwise in this subchapter, the following definitions apply: "Administrator" means the person licensed by the state, including an owner, salaried employee, or other provider, with daily responsibility for operation of the facili…

37.40.304 NURSING FACILITY SERVICES Nursing facility services are provided in accordance with 42 CFR, part 483, subpart B, or intermediate care facility services for individuals with intellectual disabilities provided in accordance with 42 CFR, part 483, subpart I. The department…

37.40.305 NURSING FACILITY SERVICES: REIMBURSABLE SERVICES Nursing facility services include but are not limited to the following or any similar items: all general nursing services, including but not limited to administration of oxygen and medications, handfeeding, incontinence c…

37.40.306 PROVIDER PARTICIPATION AND TERMINATION REQUIREMENTS Nursing facility service providers, as a condition of participation in the Montana Medicaid program must meet the following requirements: comply with and agree to be bound by all laws, rules, regulations and policies g…

37.40.307 NURSING FACILITY REIMBURSEMENT For nursing facility services provided by nursing facilities located within the state of Montana, the Montana Medicaid program will pay a provider, for each Medicaid patient day, a per-diem rate determined in accordance with this rule, min…

37.40.308 RATE EFFECTIVE DATES A provider's per diem rate effective for the rate period July 1, 2001 through June 30, 2002 and in subsequent rate years, shall be determined in accordance with ARM 37.40.307. Except as specifically provided in these rules, per diem rates and interi…

37.40.309 NURSING FACILITY REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA History: NEW, 2017 MAR p. 2320, Eff. 1/1/18; REP, 2018 MAR p. 1419, Eff. 7/21/18.

37.40.311 RATE ADJUSTMENT FOR COUNTY FUNDED RURAL NURSING FACILITIES For each state fiscal year, the department will provide a mechanism for a one time, lump sum payment to nonstate government owned or operated facilities for Medicaid services according to the methodology specifi…

37.40.313 OPERATING COST COMPONENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 685, Eff. 4/30/93; AMD, 199…

37.40.314 DIRECT NURSING PERSONNEL COST COMPONENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1992 MAR p. 1617, Eff. 7/31/92; AMD, 1993 MAR p. 1385, Eff. 7…

37.40.315 STAFFING AND REPORTING REQUIREMENTS Providers must provide: staffing at levels that are adequate to meet federal law, regulations, and requirements; and staffing, quality, and performance information on the online Monthly Nursing Facility Report, which includes informat…

37.40.320 MINIMUM DATA SET SUBMISSION, TREATMENT OF DELAYS IN SUBMISSION, INCOMPLETE ASSESSMENTS, AND CASE MIX INDEX CALCULATION Nursing facilities shall submit all minimum data set assessments and tracking documents to the Centers for Medicare and Medicaid Services (CMS) databas…

37.40.321 CORRECTION OF ERRONEOUS OR MISSING DATA The department will prepare and distribute resident listings to facilities by the 15th day of the third month of each quarter (cut off date) . The listings will identify current assessments for residents in the nursing facility on…

37.40.322 OBRA NURSE AIDE TESTING AND TRAINING COST REPORTING Omnibus Budget Reconciliation Act of 1987 (OBRA) costs will be reimbursed under the per diem rate determined under ARM 37.40.307. No further reimbursement will be provided outside the per diem rate. Each provider must …