Montana Administrative Code

37.78.811 TANF CASH ASSISTANCE EMPLOYMENT AND TRAINING: PARTICIPATION REQUIREMENTS FOR EDUCATIONAL ACTIVITIES A teen parent who is under 18, who has not completed high school or its equivalent or any other teen student referred to TANF employment and training must participate in …

37.78.812 TANF: PARTICIPATION CRITERIA UNDER PARENTS AS SCHOLARS PROGRAM The department will allow a maximum of 25 TANF recipients to continue postsecondary education activities under the Parents as Scholars Program (PAS). Twenty-five slots will be available statewide. Slots will…

37.78.817 TANF CASH ASSISTANCE EMPLOYMENT AND TRAINING: TWO-PARENT FAMILIES PARTICIPATION AND OTHER REQUIREMENTS (REPEALED) Authorizing statute(s): 53-4-212, MCA Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD,…

37.78.825 TANF EMPLOYMENT AND TRAINING: POST-SECONDARY PARTICIPATION CRITERIA (REPEALED) Authorizing statute(s): 53-4-212, MCA Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; T…

37.78.826 TANF CASH ASSISTANCE EMPLOYMENT AND TRAINING: REQUIREMENTS FOR SATISFACTORY PROGRESS IN EDUCATIONAL, WORK, AND TRAINING ACTIVITIES Satisfactory progress in educational activities must be made in accordance with the requirements of the institution the participant is atte…

37.78.830 TANF EMPLOYMENT AND TRAINING: JOB SEARCH (REPEALED) Authorizing statute(s): 53-4-212, MCA Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p.…

37.78.831 FAIM EMPLOYMENT AND TRAINING: ON-THE-JOB TRAINING (OJT) (REPEALED) Authorizing statute(s): 53-4-212, MCA Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from S…

37.78.832 TANF CASH ASSISTANCE EMPLOYMENT AND TRAINING: SUPPORTIVE SERVICES Dependent upon available funding, money may be available to pay expenses that are, or may be, incurred in a benefit month, by a TANF cash assistance participant to comply with family investment agreement …

37.78.833 TANF CASH ASSISTANCE POST-EMPLOYMENT PROGRAM Households who are losing eligibility for TANF cash assistance due to the receipt of new or increased earned income may be eligible for no more than three months of assistance under the TANF Cash Assistance Post-Employment Pr…

37.78.836 FAIM EMPLOYMENT AND TRAINING: GOOD CAUSE (REPEALED) Authorizing statute(s): 53-4-212, MCA Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p.…

37.78.837 FAIM EMPLOYMENT AND TRAINING: SANCTIONS (REPEALED) Authorizing statute(s): 53-4-212, MCA Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. …

37.78.838 FAIM EMPLOYMENT AND TRAINING: FAIR HEARING PROCEDURE (REPEALED) Authorizing statute(s): 53-4-212, MCA Implementing statute(s): 53-2-201, 53-4-211, 53-4-601, 53-4-613, MCA History: NEW, 1996 MAR p. 277, Eff. 1/26/96; AMD, 1998 MAR p. 3303, Eff. 12/18/98; AMD, 2000 MAR p.…

37.79.101 HEALTHY MONTANA KIDS (HMK) PLAN The rules in this chapter implement the Healthy Montana Kids Plan to provide comprehensive health care coverage to Montana residents who are 18 years of age or younger residing in households with a combined family income at or below 250% …

37.79.102 DEFINITIONS As used in this subchapter, unless expressly provided otherwise, the following definitions apply: "Advanced practice registered nurse (APRN)" means a registered professional nurse who has completed educational requirements related to the nurse's specific pra…

37.79.106 ELECTRONIC APPLICATIONS AND SIGNATURES The HMK Plan will accept electronic applications and signatures. Electronic signatures are allowed in compliance with the requirements of ARM Title 30, chapter 18, subchapters 106, 117, and 122 to the extent those provisions are no…

37.79.110 PROCESS FOR IDENTIFYING AND APPROVING ENROLLMENT PARTNERS The following entities are qualified to be enrollment partners: a licensed or certified health care provider; a school district; a community-based organization; a government agency; and provider associations. The…

37.79.115 ACTIVE ENROLLMENT PROCESS The department will promote the HMK Plan through a combination of traditional marketing methods and social marketing. The department will develop and maintain an enrollment partner network to encourage, assist, and actively enroll children in t…

37.79.117 PRESUMPTIVE ELIGIBILITY A family applies for a period of presumptive eligibility (PE), defined as temporary enrollment in the HMK coverage group not to exceed two consecutive calendar months within a 12-month period, for all of their uninsured children less than 19 year…

37.79.120 MOVEMENT BETWEEN HMK AND HMK PLUS The HMK Plan is available to all Montana residents who are 18 years of age or younger and live in households with a combined family income at or below 250% of the federal poverty level (FPL). The HMK Plan provides for two coverage group…

37.79.125 POINT OF ACCESS The department developed a combined Healthy Montana Kids Plan application for the HMK and HMK Plus coverage groups. The department will accept and determine eligibility for all applications for children's health coverage provided by the HMK Plan. Applica…

37.79.130 TRANSITION On October 1, 2009, all children currently enrolled in the CHIP and the Medicaid children's programs will transition from CHIP and Medicaid to the HMK Plan. The second transition will take place when current CHIP enrollees from families with income between 10…

37.79.135 PROSPECTIVE PAYMENT SYSTEM FOR FEDERALLY QUALIFIED HEALTH CENTER (FQHC) REIMBURSEMENT The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires states with separate or combined CHIP programs to pay federally qualified health centers (FQHCs) a…

37.79.140 OUTREACH EFFORTS The department will promote the HMK Plan through a combination of traditional marketing methods, social marketing, the development and maintenance of an enrollment partner network and collaborative efforts with schools, advocacy groups, health care prov…

37.79.201 ELIGIBILITY An applicant may be eligible for covered services under the HMK coverage group if: the applicant is under 19 years of age, unless the applicant qualifies for postpartum continuous eligibility coverage as defined in ARM 37.82.102; the applicant's social secur…

37.79.202 NONQUALIFYING APPLICANTS Applicants determined by the department to be eligible for the HMK Plus coverage group are eligible to receive the HMK Plus coverage group benefits but not eligible to receive the HMK coverage group benefits. Applicants who are patients in an in…

37.79.206 ELIGIBILITY REDETERMINATION, NOTICE OF CHANGES Eligibility determinations will be effective for a period of 12 months unless one or more of the following changes occurs: the enrollee moves from the state of Montana; the enrollee moves, does not notify the department of …

37.79.207 TERMINATION OF ELIGIBILITY AND GUARDIAN LIABILITY The HMK coverage group eligibility terminates immediately upon: death of the enrollee; or incarceration of the enrollee. The HMK coverage group eligibility terminates at the end of the month the department becomes aware:…

37.79.208 PROVISIONAL BENEFITS, DETERMINATION OF ELIGIBILITY, AND APPLICATIONS FOR HMK Provisional HMK coverage group benefits may be extended to enrollees who would otherwise lose health care coverage while awaiting an HMK Plus determination. Provisional coverage may be extended…

37.79.209 ELIGIBILITY VERIFICATION REVIEWS (REPEALED) Authorizing statute(s): 53-4-1009, MCA Implementing statute(s): 53-4-1004, MCA History: NEW, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; REP, 2009 MAR p. 1673, Eff. 10/1/09.

37.79.301 COVERED BENEFITS (REPEALED) Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p…

37.79.302 COVERAGE LIMITATIONS There is no lifetime limit on the dollar value of benefits per enrollee. Pre-existing conditions of each enrollee are covered as of the effective date of enrollment if the condition would be otherwise covered. A newborn of an HMK coverage group enro…

37.79.303 BENEFITS NOT COVERED (REPEALED) Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1005, 53-4-1009, 53-4-1104, 53-4-1105, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; …

37.79.304 SERVICES COVERED The department adopts and incorporates by reference the HMK Evidence of Coverage datedJanuary 1, 2024, which is available on the department's web site at www.hmk.mt.gov. The HMK Evidence of Coverage describes the health care benefits available to an HMK…

37.79.307 INPATIENT HOSPITAL BENEFITS (REPEALED) Authorizing statute(s): 53-4-1009, MCA Implementing statute(s): 53-4-1003, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; REP, 2013 MAR p. 214, Eff. 2/15/13.

37.79.308 OUTPATIENT HOSPITAL BENEFITS (REPEALED) Authorizing statute(s): 53-4-1009, MCA Implementing statute(s): 53-4-1003, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; REP, 2013 MAR p. 214, Eff. 2/15/13.

37.79.309 PHYSICIAN AND ADVANCED PRACTICE REGISTERED NURSE BENEFITS, LIMITATIONS, AND EXCLUSIONS (REPEALED) Authorizing statute(s): 53-4-1009, MCA Implementing statute(s): 53-4-1003, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; REP, 2013 M…

37.79.312 PRESCRIPTION DRUG BENEFITS (REPEALED) Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2…

37.79.313 LABORATORY AND RADIOLOGY BENEFITS (REPEALED) Authorizing statute(s): 53-4-1009, MCA Implementing statute(s): 53-4-1003, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; REP, 2013 MAR p. 214, Eff. 2/15/13.

37.79.316 MENTAL HEALTH BENEFITS (REPEALED) Authorizing statute(s): 53-4-1009, MCA Implementing statute(s): 53-4-1003, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 1027, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2010 MAR p. 1539, Eff. 7/1/10; REP…

37.79.317 SUBSTANCE USE DISORDER BENEFITS (REPEALED) Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; …

37.79.321 VISION BENEFITS Vision benefits and medical eye care include: services for the medical treatment of diseases or injury to the eye; vision exams; and a dispensing fee for eyeglasses which are ordered from the department's contractor and provided by a licensed physician, …

37.79.322 EYEGLASS BENEFITS Eyeglasses shall be paid by the department through a single volume purchase contract. An enrollee is limited to one pair of eyeglasses per 365 day period unless additional pairs are necessary due to any of the following circumstances: cataract surgery;…

37.79.325 AUDIOLOGY BENEFITS (REPEALED) Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA Implementing statute(s): 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1104, 53-4-1105, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MA…

37.79.326 DENTAL BENEFITS The maximum dental benefits paid under the basic dental plan will be 85% of the billed services received. Up to $1,615 in basic dental care will be paid per benefit year for each enrollee. For example, $1,900 in services received results in $1,615 paid. …

37.79.501 COST SHARING PROVISIONS Except as provided in (2) and (3), the parent or guardian of each HMK coverage group enrollee whose family income is greater than 100% of the federal poverty level must pay to the provider of service the following copayments not to exceed the cos…

37.79.503 ENROLLMENT The HMK coverage group will accept without restriction eligible applicants in the order in which they are received for enrollment until the maximum enrollment, at which time eligible applicants will be put on a waiting list and will be enrolled when spaces be…

37.79.504 RIGHT TO CHOOSE PRIMARY CARE PROVIDER (REPEALED) Authorizing statute(s): 53-4-1009, MCA Implementing statute(s): 53-4-1003, MCA History: NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; REP, 2008 MAR p. 49, Eff. 1/18/08.

37.79.505 DISENROLLMENT Participation in the HMK coverage group is voluntary and an enrollee may withdraw from the program at any time. HMK coverage group benefits may be terminated for good cause if the enrollee, parent, or guardian has violated rules adopted by the Montana Comm…

37.79.601 CONTRACT FOR SERVICES The department may contract as it determines appropriate and in conformity with state and federal procurement law for services to administer the HMK coverage group. Authorizing statute(s): 53-4-1004, 53-4-1009, 53-4-1105, MCA Implementing statute(s…

37.79.602 PROVISION OF BENEFITS The department may impose the following requirements in the provision of benefits: the use of certain types of providers to the extent allowed by law; prior authorization for benefits other than emergency services; directing an enrollee to the appr…