Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.40 - Targeted Case Management Services for Substance Use Disorders
Rule 37.86.4001 - TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, DEFINITIONS

Universal Citation: MT Admin Rules 37.86.4001

Current through Register Vol. 18, September 20, 2024

(1) "Adult" means a person 21 years of age or older.

(2) "Assessment" and "periodic reassessment" means determining the need for any medical, educational, social, or other services. These assessment activities include the following:

(a) taking client history;

(b) identifying the needs of the individual and completing related documentation;

(c) gathering information from other sources, such as family members, medical providers, social workers, and educators (if necessary) to form a complete assessment of the eligible individual.

(3) "Case Planning" means the development and periodic revision of a specific care plan based on the information collected through the assessment, that includes the following:

(a) specifies the goals and actions to address the medical, social, education, and other services needed by the eligible individual.

(b) includes activities such as ensuring the active participation of the eligible individual and working with the individual, the individual's authorized health care decision maker, if appropriate, or others to develop those goals.

(c) identifies a course of action to respond to the assessed needs of the eligible individual.

(4) "Coordination, referral, and related activities" means activities that help the eligible individual obtain needed services. The activities include ones that help link the individual with medical, social, and educational providers or other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

(5) "Monitoring and follow-up activities" means activities and contacts necessary to ensure the care plan is effectively implemented and adequately addresses the needs of the eligible individual. These activities may be with the person, family members, service providers, or other entities or individuals and conducted as frequently as necessary to help determine whether the following conditions have occurred:

(a) services are being furnished in accordance with the person's care plan;

(b) services in the care plan are adequate to meet the needs of the person; or

(c) change(s) occurred in the needs or status of the person.

(6) "SSA" means Social Security Act.

(7) "Substance Abuse" means a person meets requirements in DSM-IV-TR for diagnosis of: 305.00; 305.20; 305.30; 305.40; 305.50; 305.60; 305.70; or 305.90.

(8) "Substance Dependency" means a person meets requirements in DSM-IV-TR for diagnosis of: 303.90; 304.20; 304.30; 304.40; 304.60; 304.70; 304.80; 305.50; or 307.90.

(9) "Substance Use Disorders" means a person who has either a diagnosis of substance abuse and/or substance dependency.

(10) "TCM" means Targeted Case Management.

(11) "Youth" means a person from birth up to and including 20 years of age.

53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-113, MCA;

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