Current through Register Vol. 18, September 20, 2024
(1) Individual
goods and services are services, supports, or goods that enhance opportunities
to achieve outcomes related to living arrangements, relationships, and
inclusion in the community as identified and documented in the plan of
care.
(2) Individual goods and
services must fall into one of the following categories:
(a) memberships and fees; or
(b) equipment and supplies.
(a) memberships and fees;
(b) recreational activities specific to a
rehabilitative goal in the plan of care. Recreational activities provided under
individual goods and services may be covered only when they are included in a
planning outcome related to a specific residential rehabilitation goal;
or
(c) equipment and
supplies.
(3) Individual
goods and services can be used when the item or service is not covered under
any other private or publicly funded resource or other waiver
service.
(4) Individual goods and
services may pay for:
(a) repair of equipment
when the equipment meets the authorization criteria and the repair is a
cost-effective alternative;
(b) a
maintenance or insurance agreement for items that meet authorization criteria
when the maintenance agreement is expected to be cost effective;
(c) shipping and handling cost if the
shipping cost is included in the price of the item, and is being purchased
using waiver funds pursuant to the plan of care;
(d) reconditioned equipment if all
authorization criteria are met and the item is considered of adequate quality,
expected to be durable, and the cost is commensurate with the age and condition
of the item; or
(e) vitamins and
nutritional supplements when there is no other source for reimbursement and
only if the waiver recipient's licensed health care provider has prescribed the
specific items.
(5)
Individual goods and services must be:
(a)
exclusively for the benefit of the waiver recipient; and
(b) the most cost-effective alternative that
reasonably meets the assessed need of the waiver recipient.
(6) Individual goods and services
must:
(a) be directed exclusively toward the
benefit of the waive recipient; and
(b) be the least costly alternative that
reasonably meets the waiver recipient's assessed need.
(7) The service, equipment, or supply must
meet the person's medical needs or provide support in order to be independent
in daily activities and must meet one of the following criteria:
(a) promotes inclusion in the
community;
(b) increases the waiver
recipient's safety in the home environment; or
(c) decreases the need for other Medicaid
services.
(8) The cost
of the service, equipment, or supply must not compromise the waiver recipient's
health or safety by depleting their individual cost plan to the extent they
cannot receive services that provide for their health and safety.
(9) The following are not reimbursable:
(a) services, equipment, or supplies which
are experimental;
(b) room and
board;
(c) gifts, gift
certificates, gift cards, or discretionary cash;
(d) items solely for entertainment or recreational
purposes;
(e) personal hygiene
items;
(f) general clothing, food,
or beverages, except specialized dietary or clothing needs; and
(g) household furnishings, cleaning supplies,
and home maintenance.
(10) Individual goods and services projected
to exceed $1,000 annual aggregate require prior approval by the DDP regional
manager.
AUTH:
53-6-113,
53-6-402, MCA; IMP:
53-6-101,
53-6-402,
MCA
