Montana Administrative Code

37.80.206 ABSENT DAYS (REPEALED) Authorizing statute(s): 52-2-704, MCA Implementing statute(s): 52-2-704, MCA History: NEW, Eff. 4/5/76; AMD, 1985 MAR p. 945, Eff. 7/12/85; TRANS, from Dept. of SRS, 1987 MAR p. 1492, Eff. 7/1/87; AMD, 1991 MAR p. 2261, Eff. 11/28/91; TRANS & AMD,…

37.80.207 BEST BEGINNINGS CHILD CARE SCHOLARSHIP PRESCHOOL The Best Beginnings Child Care Scholarship will not reimburse child care services during preschool program hours at any of the following settings: public preschool settings, described in ARM 10.63.101; state funded presch…

37.80.208 CARE PROVIDED IN THE CHILD'S HOME Child care assistance paid for care provided in a child's home must be approved by the department's Early Childhood Services Bureau. Subsidized care provided in a child's home can only be paid to approved Family, Friend, and Neighbor an…

37.80.301 REQUIREMENTS FOR CHILD CARE FACILITIES, COMPLIANCE WITH EXISTING RULES, CERTIFICATION Child care facilities must be in compliance with the licensing and registration requirements ARM Title 37, chapter 95 to receive payment under this chapter. Loss of eligibility for fun…

37.80.305 LEGALLY CERTIFIED PROVIDERS: INTRODUCTION (REPEALED) Authorizing statute(s): 52-2-704, MCA Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1997 MAR p. 578, Eff. 3/25/97; TRANS & …

37.80.306 LEGALLY CERTIFIED PROVIDERS: CERTIFICATION REQUIREMENTS AND PROCEDURES (REPEALED) Authorizing statute(s): 52-2-704, MCA Implementing statute(s): 52-2-704, 52-2-713, 52-2-721, 52-2-722, 52-2-723, 52-2-731, MCA History: NEW, 1992 MAR p. 1863, Eff. 8/28/92; AMD, 1993 MAR p…

37.80.315 RIGHTS AND RESPONSIBILITIES AGREEMENT In addition to complying with all other certification requirements, providers must sign a rights and responsibilities agreement under this chapter, on the form provided by the department. Parents are provided a copy of the providers…

37.80.316 REQUIREMENTS AND PROCEDURES FOR CHILD CARE PAYMENTS Except as provided in (2) and (3), the provider will receive payment for child care services when the care is provided outside the child's home. Payment will be made to the parent when a care giver, who does not live w…

37.80.317 AUTHORIZATION OF SERVICES – AUTHORIZATION PLANS Child care assistance is provided for through an authorization of services and an authorization plan. The authorization of services and authorization plan include the following information: number of children authorized to…

37.80.501 TERMINATION OF CHILD CARE ASSISTANCE Child care assistance will be terminated if any of the following occurs: the household does not apply for redetermination; a parent has been given a grace period and does not meet the activity requirement or is not participating in t…

37.80.502 CHILD CARE OVERPAYMENT A child care provider or a parent who has reason to believe an overpayment or underpayment of child care assistance has occurred must notify the department within ten days. If an audit of the case shows monies received fall under ARM 37.80.506(1)(…

37.80.506 INTENTIONAL PROGRAM VIOLATIONS An intentional program violation occurs when: a parent or guardian receives, or attempts to receive, child care assistance based on a false or misleading statement, misrepresentation, concealment, or withholding of relevant facts or inform…

37.80.507 INTENTIONAL PROGRAM VIOLATION SANCTIONS The department has the discretion, based on the circumstances of the violation, to determine the appropriate sanction for the first intentional program violation. The department may impose any of the following sanctions on a paren…

37.80.601 BEST BEGINNINGS QUALITY CHILD CARE MINI GRANTS (REPEALED) Authorizing statute(s): 52-2-704, 53-2-201, 53-4-212, MCA Implementing statute(s): 52-2-704, MCA History: NEW, 2002 MAR p. 1553, Eff. 5/31/02; REP, 2008 MAR p. 174, Eff. 2/1/08.

37.80.602 BEST BEGINNINGS QUALITY CHILD CARE MERIT PAY (REPEALED) Authorizing statute(s): 52-2-704, 53-2-111, MCA Implementing statute(s): 52-2-704, 52-2-111, 52-2-112, 52-2-711, MCA History: NEW, 2002 MAR p. 1989, Eff. 5/31/02; AMD, 2005 MAR p. 1057, Eff. 7/1/05; REP, 2008 MAR p…

37.80.603 INFANT/TODDLER CARE GIVER CERTIFICATION (REPEALED) Authorizing statute(s): 52-2-111, 52-2-704, 53-2-201, MCA Implementing statute(s): 52-2-704, MCA History: NEW, 2002 MAR p. 1553, Eff. 5/31/02; REP, 2008 MAR p. 174, Eff. 2/1/08.

37.80.604 REQUIREMENTS FOR CHILD CARE FACILITY PARTICIPATION IN THE BEST BEGINNINGS STAR QUALITY TIERED REIMBURSEMENT PROGRAM (REPEALED) Authorizing statute(s): 52-2-704, 53-4-212, MCA Implementing statute(s): 52-2-704, 52-2-721, 53-4-212, MCA History: NEW, 2005 MAR p. 1057, Eff.…

37.81.1001 MONTANA PHARMASSIST PROGRAM The rules in this chapter implement the Prescription Drug Consumer Information and Technical Assistance Program established in 53-6-1006, MCA. This program is referred to in these rules as the Montana PharmAssist Program. Authorizing statute…

37.81.1002 RULE DEFINITIONS In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter: "Application" means the form developed by the department to provide the program with client specific information. "Authorized client" means an applicant …

37.81.1005 MONTANA PHARMASSIST SCOPE AND PURPOSE Beginning July 15, 2007, Montana residents may request applications for referral to a credentialed pharmacist for review of their medication regimens to address medication cost and the proper and prudent use of their medications. C…

37.81.1008 AMOUNT OF PHARMASSIST BENEFIT If eligible for Montana PharmAssist, a client may receive up to $200 of pharmacist services per 12 month period as outlined in the pharmacist's Personal Service Contract. Services will include an initial face-to-face consultation and may i…

37.81.1009 ELIGIBILITY FOR MONTANA PHARMASSIST An applicant must be qualified, eligible, and authorized to receive pharmacist services. To qualify, an applicant must have a chronic disease and either: take four or more medications; or have a condition or health issue determined b…

37.81.101 BIG SKY RX PROGRAM The rules in this chapter implement the Pharmacy Access Prescription Drug Benefit program established in 53-6-1004 , MCA. This program is referred to in these rules as the Big Sky Rx program. Authorizing statute(s): 53-2-201, 53-6-1004, MCA Implementi…

37.81.1012 PROCESSING MONTANA PHARMASSIST APPLICATIONS The department or its designee will process PharmAssist Patient Packets on a first in first served basis using the date the complete package is received. Authorized clients will be referred to a pharmacist for services. Appli…

37.81.1013 MAINTENANCE OF A WAITING LIST FOR THOSE DETERMINED ELIGIBLE FOR MONTANA PHARMASSIST The department will process PharmAssist Patient Packets and notify eligible individuals in writing if no available program slot exists, either due to lack of appropriations or credentia…

37.81.1018 MONTANA PHARMASSIST To participate in the PharmAssist Program a pharmacist must be licensed by the state of Montana and complete initial training, which consists of a self-guided educational packet prepared by the department. Authorizing statute(s): 53-2-201, 53-6-1006…

37.81.1020 MONTANA PHARMASSIST GRIEVANCE AND APPEAL All decisions of the department related to the administration of the Montana PharmAssist are reviewable using the procedures in ARM 37.5.101, 37.5.304, 37.5.307, 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, and 37…

37.81.104 DEFINITIONS In addition to the definitions in 53-6-1001, MCA, the following definitions apply to this chapter: "Assets" mean cash or other resources that a person owns and could convert to cash to be used for his or her support and maintenance. "Closed" means an individ…

37.81.301 BIG SKY RX SCOPE AND PURPOSE On January 1, 2006, Medicare Prescription Drug Plans (PDPs) became available to people with Medicare. This is a voluntary federal program created by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) 42 USC 1302, …

37.81.304 AMOUNT OF THE BIG SKY RX BENEFIT An applicant eligible for the Big Sky Rx PDP premium assistance may receive a benefit not to exceed $41.50 per month. The benefit amount will not exceed $41.50 regardless of the cost of the premium for the PDP the individual chooses. If …

37.81.307 ELIGIBILITY FOR BIG SKY RX An applicant must be eligible and enrolled in the program to receive premium assistance. To qualify the applicant must: be a resident of the state of Montana; and have a family income at or below 200% FPL. An applicant who meets the eligibilit…

37.81.310 INCOME AND FAMILY SIZE CRITERIA FOR BIG SKY RX Family income must be at or below 200% FPL to qualify for the program. Assets are not considered. Family income is the total of the applicant's income and the spouse's income if married and living together. For purposes of …

37.81.314 MAXIMUM BIG SKY RX PROGRAM ENROLLMENT The department will enroll the number of participants it determines can be served based on the amount of appropriation. Authorizing statute(s): 53-2-201, 53-6-1004, MCA Implementing statute(s): 53-6-1001, 53-6-1004, 53-6-1005, MCA H…

37.81.318 PROCESSING BIG SKY RX PARTICIPANT APPLICATIONS The department will process applications on a first in first served basis using the date the application is received by the department. The program will not enroll or pay benefits retroactively. Benefits will only be paid t…

37.81.322 BIG SKY RX APPLICATION RENEWAL Sixty days prior to the end of the 12-month eligibility period, a prepopulated notice will automatically be generated and mailed to the client. This notice is generated based on the client's eligibility enrollment determination date. The c…

37.81.326 MAINTENANCE OF A WAITING LIST FOR THOSE DETERMINED ELIGIBLE FOR BIG SKY RX The department will process applications and will notify eligible individuals in writing of their program status. If no available program slot exists, the eligible individuals will not be enrolle…

37.81.330 BIG SKY RX GRIEVANCE AND APPEAL PROCEDURES All decisions of the department related to the administration of the Big Sky Pharmacy Rx program are reviewable using the procedures stated at ARM 37.5.101, 37.5.304, 37.5.307, 37.5.313, 37.5.318, 37.5.322, 37.5.325, 37.5.328, …

37.81.334 BIG SKY RX APPEAL PROCEDURES Hearings to contest adverse department actions under the Big Sky Rx program, Title 53, chapter 6, part 10, MCA, are available to the extent granted by statute or rule in accordance with ARM 37.81.330. Authorizing statute(s): 53-2-201, 53-6-1…

37.81.338 VERIFICATION OF ELIGIBILITY FOR BIG SKY RX A random sample of enrolled individuals will be required to participate in an eligibility verification review and provide documentation to verify the income as stated on the application. An individual will have 30 days from the…

37.81.342 BIG SKY RX PREMIUM PAYMENTS Monthly premium payments will be made: to an insurer that has contracted with the department; directly to clients if: their monthly premium is deducted from their Social Security check; they enroll in a PDP provided by an insurer that does no…

37.81.346 BIG SKY RX PDP MEMORANDUM OF UNDERSTANDING (MOU) AND BUSINESS ASSOCIATES AGREEMENT (BAA) An insurer receiving direct payment of all or part of a PDP premium from the state on behalf of an enrollee must enter into a Memorandum of Understanding (MOU) or Business Associate…

37.81.9004 APPLICATION FOR MEDICARE PART D LOW INCOME PREMIUM AND COST SHARING SUBSIDIES (LIS) (REPEALED) Authorizing statute(s): 53-2-201, MCA Implementing statute(s): 53-2-201, MCA History: NEW, 2006 MAR p. 575, Eff. 2/24/06; REP, 2008 MAR p. 954, Eff. 5/9/08.

37.81.9005 PROCESSING OF APPLICATIONS FOR LIS (REPEALED) Authorizing statute(s): 53-2-201, MCA Implementing statute(s): 53-2-201, MCA History: NEW, 2006 MAR p. 575, Eff. 2/24/06; REP, 2008 MAR p. 954, Eff. 5/9/08.

37.81.9006 EFFECTIVE DATE OF ELIGIBILITY FOR LIS (REPEALED) Authorizing statute(s): 53-2-201, MCA Implementing statute(s): 53-2-201, MCA History: NEW, 2006 MAR p. 575, Eff. 2/24/06; REP, 2008 MAR p. 954, Eff. 5/9/08.

37.81.9009 REDETERMINATIONS OF ELIGIBILITY FOR LIS (REPEALED) Authorizing statute(s): 53-2-201, MCA Implementing statute(s): 53-2-201, MCA History: NEW, 2006 MAR p. 575, Eff. 2/24/06; REP, 2008 MAR p. 954, Eff. 5/9/08.

37.81.9010 APPEAL PROCESS FOR LIS APPLICATIONS (REPEALED) Authorizing statute(s): 53-2-201, MCA Implementing statute(s): 53-2-201, MCA History: NEW, 2006 MAR p. 575, Eff. 2/24/06; REP, 2008 MAR p. 954, Eff. 5/9/08.

37.82.1002 MEDICAID FOR WORKERS WITH DISABILITIES: DEFINITIONS The following definitions apply to this subchapter: "Employed" means engaged in work for which the individual receives or seeks to receive income, either as an employee or as a self-employed person. An individual is c…

37.82.1003 MEDICAID FOR WORKERS WITH DISABILITIES: APPLICABLE LAW Except as specifically provided in this subchapter or in the Aged Blind Disabled (ABD) Medicaid Manual adopted and incorporated by reference in ARM 37.82.101, the Medicaid for Workers with Disabilities program shal…

37.82.1004 MEDICAID FOR WORKERS WITH DISABILITIES: GENERAL ELIGIBILITY CRITERIA An individual is eligible for benefits through the Medicaid for Workers with Disabilities program if the individual: is employed; has a disability as defined in 42 USC 1382c, except that the criteria …

37.82.1005 MEDICAID FOR WORKERS WITH DISABILITIES: INCOME An individual is eligible for benefits through the Medicaid for Workers with Disabilities program in regard to income if the individual's net family income is less than 250% of the 2011 U.S. Department of Health and Human …