Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.39 - Case Management Services for Children with Special Health Care Needs
Rule 37.86.3910 - TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, REIMBURSEMENT

Universal Citation: MT Admin Rules 37.86.3910

Current through Register Vol. 18, September 20, 2024

(1) Targeted case management services for children and youth with special health care needs are reimbursed at the lower of the following:

(a) the provider's customary charge to the general public for the service; or

(b) the department's current fee schedule under ARM 37.85.105.

(2) The following activities may not be billed as targeted case management and are not reimbursable as a unit of targeted case management:

(a) outreach to the child or child's caregiver(s);

(b) application activities related to Medicaid services or eligibility;

(c) direct medical services, including counseling or the transportation or escort of members;

(d) duplicate payments that are made to providers under Medicaid or other program authorities;

(e) writing, recording, or entering case notes for the member's files;

(f) travel to and from member activities;

(g) coordination of the investigation of any suspected abuse, neglect, or exploitation cases; and

(h) any service less than eight minutes duration if it is the only service provided that day.

(3) Targeted case management services are not separately billable for members enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program.

(4) All targeted case management services must meet the guidelines of medical necessity set forth in ARM 37.85.410.

AUTH: 53-6-113, MCA; IMP: 53-6-101, MCA

Disclaimer: These regulations may not be the most recent version. Montana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.