reglab/housing_qa huggingface dataset:
MT Code § 53-6-407 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 4. Home and Community-Based Long-Term Care Medicaid Services|53-6-407. Notification required before termination of waiver participation

  53-6-407. Notification required before termination of waiver participation. (1) The department shall notify a person participating in a medicaid home and community-based services waiver at least 30 days before terminating the person's participation in the waiver. The department shall:  (a) notify the person of the planned termination from the program by mail; and   (b) allow the person to provide the department with information demonstrating the person's continued need for waiver services. The information must be provided within 30 days of the date the notification was mailed.   (2) (a) The department may terminate the person's participation in the waiver at the end of the 30-day period provided for in subsection (1) if:   (i) the person has not responded to the notification; or   (ii) after reviewing information provided by the person, the department has determined the person is no longer eligible to participate in the waiver.   (b) If the department determines that the person is no longer eligible to participate in the waiver, the department must notify the person by mail before the expiration of the 30-day notification period.   (3) The termination notice provided for in subsection (2) must state that:   (a) the decision may be appealed in accordance with 53-2-606;   (b) the person may request continued services during the period of the appeal; and   (c) the department will not seek reimbursement of services provided during the period of appeal unless the department finds evidence of fraud or other similar circumstances indicating waiver services were not warranted.   (4) An appeal must be filed within 90 days of the mailing date of the termination notice provided for in subsection (2).   History: En. Sec. 1, Ch. 257, L. 2021.
MT Code § 53-6-408 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 4. Home and Community-Based Long-Term Care Medicaid Services|53-6-408. through 53-6-412 reserved

  53-6-408 through 53-6-412 reserved.
MT Code § 53-6-413 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 4. Home and Community-Based Long-Term Care Medicaid Services|53-6-413. Substantive changes to waiver provisions -- rulemaking requirements -- definition

  53-6-413. Substantive changes to waiver provisions -- rulemaking requirements -- definition. (1) The department may not make a substantive change to the services offered under an approved waiver or to the eligibility requirements or process for waiver participants unless the department:  (a) adopts rules to implement the changes; and   (b) if necessary, submits a waiver amendment to the centers for medicare and medicaid services and receives approval for the change.   (2) (a) For the purposes of this section, "substantive change" means a change that:   (i) reduces, limits, or otherwise establishes caps on the amount or duration of a service; or   (ii) limits a person's ability to access waiver services.   (b) The term includes but is not limited to changes requiring:   (i) preauthorization before a service is provided;   (ii) preauthorization before an individual is placed on the waiting list for services; or   (iii) that services be used within a specific, shorter time period than previously allowed.   History: En. Sec. 1, Ch. 258, L. 2021.
MT Code § 53-6-501 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 5. Traumatic Brain Injury -- Services|53-6-501. Traumatic brain injury defined

  53-6-501. Traumatic brain injury defined. (1) (a) As used in 53-6-502 and this section, "traumatic brain injury" means:   (i) an injury to the brain caused by an external physical force, including but not limited to a motor vehicle accident, a fall, an assault, a sports injury, or a recreational or work-related accident; or   (ii) brain damage caused by an internal occurrence including but not limited to:   (A) disease, such as a benign or malignant tumor, meningitis, or encephalitis; or   (B) a cerebrovascular accident, such as stroke, atherosclerosis, aneurysm, or arteriovenous malformation; or   (C) anoxia, including but not limited to anoxia caused by near drowning, drug overdose, kidney or heart failure, chemical exposure, or electrical shock.   (b) The term "traumatic brain injury" does not include injuries of a degenerative or congenital nature.   (2) Traumatic brain injury as defined in this section may produce a diminished or altered state of consciousness that results in a temporary or permanent impairment of cognitive or mental abilities, physical functioning, or behavioral or emotional functioning.   History: En. Sec. 1, Ch. 591, L. 1993.
MT Code § 53-6-502 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 5. Traumatic Brain Injury -- Services|53-6-502. Traumatic brain injury trust fund established -- source of funds -- uses

  53-6-502. Traumatic brain injury trust fund established -- source of funds -- uses. (1) There is an account in the state special revenue fund to be used to establish a traumatic brain injury trust fund.   (2) The trust fund consists of donations or grants received for the purpose of providing services for persons suffering from traumatic brain injury.   (3) The money in this account must be used solely for planning, coordinating, and providing services to persons suffering from traumatic brain injury.   History: En. Sec. 2, Ch. 591, L. 1993.
MT Code § 53-6-601 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 6. Long-Term Care Reform|53-6-601. Short title

  53-6-601. Short title. This part may be cited as the "Montana Long-Term Care Reform Act".   History: En. Sec. 1, Ch. 384, L. 1995.
MT Code § 53-6-602 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 6. Long-Term Care Reform|53-6-602. Purpose -- policy

  53-6-602. Purpose -- policy. (1) The legislature finds that in keeping with the traditional concept of the inherent dignity of the individual in a democratic society, the elderly or persons with disabilities should be able to live as independently as possible.   (2) The legislature further finds that:   (a) the ability to continue to live in a person's own residence or in the least restrictive setting best serves the health and dignity of the elderly or persons with disabilities;   (b) state programs of assistance for the elderly or persons with disabilities should be coordinated in a manner that best serves the interests of the recipients;   (c) state programs of assistance for the elderly or persons with disabilities should encourage the development of services that support the maintenance of lives as independently as possible;   (d) state programs of assistance for the elderly or persons with disabilities should encourage the development of affordable services for persons seeking services, whether financed through private means or public means;   (e) the elderly or persons with disabilities should be able to obtain insurance and other means of private financing for services that are affordable and readily available; and   (f) state agencies are required to carry out their various responsibilities for the provision of assistance, the protection of the elderly and persons with disabilities, and the licensing of facilities and professions in accordance with this part.   (3) The legislature declares that the policy of this state is to:   (a) respect the dignity of persons in the provision of state-sponsored and state-funded services for the elderly and persons with disabilities by seeking to maintain the maximum level of independence possible for those persons receiving services;   (b) foster the development of community services that allow a person to choose to remain in a person's own residence or in the least restrictive setting;   (c) foster coordination of services for the elderly or persons with disabilities among the various public and private programs; and   (d) foster the development of private means of financing services for the elderly or persons with disabilities.   History: En. Sec. 2, Ch. 384, L. 1995.
MT Code § 53-6-603 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 6. Long-Term Care Reform|53-6-603. Long-term care service development -- coordination -- delivery

  53-6-603. Long-term care service development -- coordination -- delivery. (1) The department of public health and human services shall cooperate in the development, implementation, and coordination of state programs of assistance for the elderly or persons with disabilities.   (2) The planning and delivery systems that provide state programs of assistance for the elderly and persons with disabilities must be jointly coordinated to foster:   (a) efficient and cost-effective financing, service delivery, intake, eligibility, assessment, and other measures, as appropriate; and   (b) general development of service systems that may serve persons with either private means or public means of financing services at a reasonable cost.   (3) State programs of assistance for the elderly or for persons with disabilities should be made available in the most appropriate, most cost-effective, and least restrictive residential setting integrated into a community.   (4) State programs of assistance that provide services or oversight in order to maintain or to protect a person's health and social life should recognize the person's dignity and independence.   History: En. Sec. 3, Ch. 384, L. 1995.
MT Code § 53-6-701 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-701. Policy of medicaid managed care -- system for integrated health care services

  53-6-701. Policy of medicaid managed care -- system for integrated health care services. It is the public policy of the state of Montana to adopt, to the extent practicable, a health care system that encourages the integration of health care services and that manages the health care of enrollees to improve their health while preserving reasonable choice within a competitive and cost-efficient environment. In furtherance of this public policy, the department shall develop and implement integrated health care programs consistent with the provisions of this part. The provisions of this part apply only to programs created under this part. The department shall by rule identify persons eligible for enrollment in a program. The department shall inform enrollees of their choice, if any, among health care delivery systems. Persons enrolled in a program may also be offered cost-effective indemnity insurance plans, subject to availability.   History: En. Sec. 1, Ch. 502, L. 1995; amd. Sec. 4, Ch. 466, L. 2001.
MT Code § 53-6-702 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-702. Definitions

  53-6-702. Definitions. As used in this part, the following definitions apply:   (1) "Department" means the department of public health and human services.   (2) "Health maintenance organization" means a health maintenance organization as defined in 33-31-102.   (3) (a) "Managed health care entity" or "entity" means a health maintenance organization or an insurer regulated under Title 33 that:   (i) contracts for an estimated annual value of $1 million or more of state and federal medicaid funds; or   (ii) operates statewide or covers 20% or more of the medicaid population.   (b) The term does not include:   (i) a provider of health care services under a contract with the department on a fee-for-service basis;   (ii) a medicaid primary care case management service within the meaning of 42 CFR 438; or   (iii) a PACE organization as defined in 42 CFR 460.6 or an accountable care organization as defined in 33-31-102 that has received a waiver under 33-31-201.   (4) "Program" means an element of the integrated health care system created by this part.   History: En. Sec. 2, Ch. 502, L. 1995; amd. Sec. 5, Ch. 466, L. 2001; amd. Sec. 3, Ch. 401, L. 2003; amd. Sec. 4, Ch. 403, L. 2003; amd. Sec. 3, Ch. 195, L. 2009; amd. Sec. 4, Ch. 346, L. 2011.
MT Code § 53-6-703 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-703. Repealed

  53-6-703. Repealed. Sec. 11, Ch. 351, L. 2011.   History: En. Sec. 3, Ch. 502, L. 1995; amd. Sec. 9, Ch. 577, L. 1999; amd. Sec. 6, Ch. 466, L. 2001; amd. Sec. 64, Ch. 130, L. 2005; amd. Sec. 10, Ch. 426, L. 2009.
MT Code § 53-6-704 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-704. Different benefit packages

  53-6-704. Different benefit packages. (1) The department may by rule provide for different benefit packages for different categories of persons enrolled in the program. Alcohol and substance abuse services, services for mental disorders, services related to children with chronic or acute conditions requiring longer-term treatment and followup, and rehabilitation care provided by a freestanding rehabilitation hospital or a rehabilitation unit may be excluded from a benefit package and those services may be made available through a separate delivery system. If a service is excluded from the program but made available in a separate delivery system by a managed health care entity, that managed health care entity is subject to this part. An exclusion does not prohibit the department from developing and implementing demonstration projects for categories of persons or services. Benefit packages for persons eligible for medical assistance under Title 53, chapter 6, parts 1 and 4, may be based on the requirements of those parts and must be consistent with the Title XIX of the Social Security Act. This part applies only to services purchased by the department.   (2) The program established by this part may be implemented by the department in various contracting areas at various times. The health care delivery systems and providers available under the program may vary throughout the state. Except as otherwise provided in a contract for mental health services and subject to the public comment and review provisions of 53-6-710 and 53-6-711, a licensed managed health care entity must be permitted to contract in any geographic area for which it has a sufficient provider network and that otherwise meets the requirements of the state contract.   History: En. Sec. 4, Ch. 502, L. 1995; amd. Sec. 10, Ch. 577, L. 1999; amd. Sec. 7, Ch. 351, L. 2011.
MT Code § 53-6-706 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-706. Requirements relating to enrollees

  53-6-706. Requirements relating to enrollees. (1) All individuals enrolled in the program must be provided with a full written explanation of all fee-for-service and managed health care plan options as provided by rule. The department shall provide to enrollees, upon enrollment in the program and at least annually, notice of the process for requesting an appeal under the department's administrative appeal procedures. The department shall maintain a toll-free telephone number for program enrollees' use in reporting problems with managed health care entities.   (2) If an individual becomes eligible for participation in the program while the individual is hospitalized, the department may, but is not required to, enroll the individual in the program prior to the individual's discharge from the hospital. This subsection does not apply to a newborn infant whose mother is enrolled in the program.   (3) The department shall, by rule, establish rates for managed health care entities that:   (a) are in accordance with federal requirements and with the department's current payment system;   (b) take into account any difference of cost to provide health care to different populations based on age and eligibility category. The rates for managed health care entities must be determined on a capitated basis.   (c) are based on treatment settings reasonably available to enrollees.   History: En. Sec. 6, Ch. 502, L. 1995; amd. Sec. 11, Ch. 577, L. 1999.
MT Code § 53-6-707 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-707. Payment reductions and adjustments -- freedom to contract

  53-6-707. Payment reductions and adjustments -- freedom to contract. (1) The department shall by rule establish a method to reduce its payments to managed health care entities to take the following into consideration:   (a) any adjustment payments paid to health care facilities under subsection (2)(b) to the extent that those payments or any part of those payments have been taken into account in establishing capitated rates under 53-6-705; and   (b) the implementation of methodologies to limit financial liability for managed health care entities under 53-6-705.   (2) For key services provided by a hospital or nursing facility that contracts with an entity, adjustment payments that are not included in capitated rates must be paid directly to the hospital or nursing facility by the department. Adjustment payments include but are not limited to:   (a) adjustment payments to disproportionate share hospitals as defined by department rule;   (b) perinatal center payments;   (c) payments for direct medical education, indirect medical education, and certified registered nurse anesthetists;   (d) supplemental medicaid payments to hospitals made pursuant to 53-6-149; and   (e) supplemental medicaid payments to nursing facilities made pursuant to 15-60-211.   (3) For any hospital or nursing facility eligible for the adjustment payments described in this section, the department shall maintain, through the period ending June 30, 1996, reimbursement levels in accordance with statutes and rules in effect at the time the payments are made.   (4) The department may not assign an existing agreement with a medicaid provider to a managed health care entity. The managed health care entity shall enter into a new agreement with a provider in order for the provider to be considered a part of the managed health care entity's network of providers.   (5) This part does not limit or otherwise impair the authority of the department to enter into a contract, negotiated pursuant to this part, with a managed health care entity, including a health maintenance organization, that provides for termination or nonrenewal of the contract without cause upon notice as provided in the contract and without a hearing. If available funds are not sufficient to provide medical assistance for all eligible persons, the department may set priorities to limit, reduce, or otherwise curtail the amount, scope, or duration of the medical services made available under the Montana medicaid program and managed care.   History: En. Sec. 7, Ch. 502, L. 1995; amd. Sec. 9, Ch. 351, L. 2011.
MT Code § 53-6-708 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-708. Waiver

  53-6-708. Waiver. The department may seek and obtain any necessary authorization provided under federal law to implement the program, including the waiver of any federal statutes or regulations. The department may not expand eligibility requirements unless authorized by the legislature. The department may seek a waiver of the federal requirement that the combined membership of medicare and medicaid enrollees in a managed health care entity may not exceed 75% of the managed health care entity's total enrollment. The department may not seek a waiver of the inpatient hospital reimbursement methodology in 42 U.S.C. 1396a(a)(13) even if the federal agency responsible for administering Title XIX determines that 42 U.S.C. 1396a(a)(13) applies to managed health care systems.   History: En. Sec. 8, Ch. 502, L. 1995; amd. Sec. 239, Ch. 42, L. 1997.
MT Code § 53-6-709 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 7. Medicaid Managed Care|53-6-709. Legislative auditor -- oversight

  53-6-709. Legislative auditor -- oversight. (1) In order to prevent, detect, and eliminate fraud, waste, abuse, mismanagement, and misconduct and to determine that the program is administered fairly and effectively, the legislative auditor shall oversee the managed care covered by this part.   (2) A medical provider may not be compelled to provide individual medical records of patients unless the records are provided in accordance with the provisions of the Government Health Care Information Act. State and local governmental agencies shall provide the requested information, assistance, or cooperation.   (3) All activities conducted by the legislative auditor must be conducted in a manner that ensures the preservation of evidence for use in criminal prosecutions. The legislative auditor may present for prosecution the findings of any activity to the office of the attorney general or to United States attorneys in Montana.   (4) The legislative auditor shall report all convictions, terminations, and suspensions taken against vendors, contractors, and health care providers to the department and to any agency responsible for licensing or regulating those persons or entities.   (5) The legislative auditor shall make periodic reports, findings, and recommendations regarding its oversight activities authorized by this section.   (6) This part does not limit investigations by the department that may otherwise be required by law or that may be necessary in the department's capacity as the central administrative authority responsible for administration of public aid programs in this state.   History: En. Sec. 9, Ch. 502, L. 1995; amd. Sec. 12, Ch. 577, L. 1999.