Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.51 - Passport to Health Program
Rule 37.86.5111 - PASSPORT TO HEALTH PROGRAM: PRIMARY CARE PROVIDERS REQUIREMENTS

Universal Citation: MT Admin Rules 37.86.5111

Current through Register Vol. 18, September 20, 2024

(1) A primary care provider must meet the following requirements:

(a) enroll as a Medicaid provider;

(b) provide primary care;

(c) sign a Passport agreement for primary care case management; and

(d) keep a paper or electronic log, spreadsheet, or other record of all Passport referrals given and received.

(2) A primary care provider may be subject to utilization review to determine that the care and services provided through the program are fulfilling the provisions of the primary care case management agreements with the program and are only those which are medically necessary or otherwise permissible.

(3) Passport providers who reach their specified caseloads of Passport patients, per their provider agreements with the department, will not be assigned additional members. Providers who have reached their capacity will be provided the opportunity to increase their caseloads. Providers that are not provider-based as described at ARM 37.86.3031 may request an exemption from this rule.

53-2-201, 53-6-113, MCA; IMP, 53-6-116, MCA;

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