Current through Register Vol. 18, September 20, 2024
(1) 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 in this rule.
(2) A person is qualified to be considered
for enrollment in the program if the person:
(a) meets one of the following criteria:
(i) is 65 years of age or older; or
(ii) is certified as disabled by the social
security administration but does not have a primary diagnosis of mental
retardation or serious mental illness.
(b) is Medicaid eligible;
(c) requires the level of care of a nursing
facility as determined in accordance with the preadmission screening provided
for in ARM
37.40.202,
37.40.205,
37.40.206, and
37.40.207; and
(d) has needs that can be met through the
program.
(3) The
department considers for an available opening for services those persons who,
as determined by the department:
(a) are
actively seeking services;
(b) are
in need of the services available;
(c) are likely to benefit from the available
services; and
(d) have a projected
total cost of service plan that is within the limits specified at ARM
37.40.1421.
(4) The department offers an available
opening for services to the person, as determined by the department, who is
most in need of the available services and most likely to benefit from the
available services.
(5) Factors to
be considered in the determinations of whether a person is in need of the
available services and likely to benefit from those services and as to which
person is most likely to benefit from the available services include, but are
not limited to, the following:
(a) medical
condition;
(b) degree of
independent mobility;
(c) ability
to be alone for extended periods of time;
(d) presence of problems with
judgment;
(e) presence of a
cognitive impairment;
(f) prior
enrollment in the program;
(g)
current institutionalization or risk of institutionalization;
(h) risk of physical or mental deterioration
or death;
(i) willingness to live
alone;
(j) adequacy of
housing;
(k) need for adaptive aids
or environmental modifications;
(l)
need for 24-hour supervision;
(m)
need of person's caregiver for relief;
(n) need, in order to receive services, of a
waiver of the Medicaid deeming financial eligibility requirement;
(o) appropriateness for the person, given the
person's current needs and risks, of services available through the
program;
(p) status of current
services being purchased otherwise for the person; and
(q) status of support from family, friends,
and community.
(6) A
person enrolled in the program may be removed from the program by the
department. Bases for removal from the program, include, but are not limited
to, the following:
(a) a determination by the
case management team or program managers that the services, as provided for in
the service plan, are no longer appropriate or effective in relation to the
person's needs;
(b) the failure of
the person to use the services as provided for in the service plan;
(c) the behaviors of the person place the
person, caregivers or others at serious risk of harm or substantially impede
the delivery of services as provided for in the service plan;
(d) the health of the person is deteriorating
or in some other manner placing the person at serious risk of harm;
(e) a determination by the case management
team or program managers that the service providers necessary to the delivery
of services as provided for in the service plan are unavailable; and
(f) a determination that the total cost of
service plan is not within the limits specified at ARM 37.40.1421.
53-2-201,
53-6-101,
53-6-113,
53-6-402,
MCA; IMP,
53-2-201,
53-6-101,
53-6-113,
53-6-131,
53-6-402,
MCA;
