Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.17 - Family Planning Services
Rule 37.86.1707 - 1115 PLAN FIRST WAIVER

(1) "Plan First" refers to Montana's Social Security Act Section 1115 Waiver titled Plan First. This waiver is approved by the Centers for Medicare & Medicaid Services and managed by the Department of Public Health and Human Services (DPHHS) with eligibility determined by the Office of Public Assistance (OPA).

(2) A woman may receive coverage through Plan First if they are not eligible for other Medicaid benefits and:

(3) Except as otherwise provided in this rule, the limited Plan First benefits are available to all persons who are members of Plan First under this chapter.

(4) Services covered under Plan First are limited to family planning and family planning-related services.

(5) Plan First is a Medicaid program, and as a condition of participation in Montana Medicaid, all providers must comply with provider participation rules set forth in ARM 37.85.401 and the billing, reimbursement, claims processing, and payment provisions set forth in ARM 37.85.406.

(6) The procedure billing codes specific to Plan First are available at the Medicaid provider website located at https://medicaidprovider.mt.gov/planfirst.

(7) The Medicaid Program will not reimburse providers for services rendered to Plan First members for billing codes not listed on the website referred to in (6).

(8) Providers are responsible for confirming Medicaid eligibility and for identifying Plan First members to ensure the provider seeks Medicaid reimbursement for only those services that are covered by Plan First.