reglab/housing_qa huggingface dataset:
MT Code § 53-6-1402 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1402. Overpayment audit procedures -- provider records -- limitations on record requests and reviews -- onsite audits

  53-6-1402. Overpayment audit procedures -- provider records -- limitations on record requests and reviews -- onsite audits. (1) When conducting an overpayment audit, the department or an auditor shall:   (a) allow the provider at least 30 days to comply with a request to provide records;   (b) include in a request for records adequate information to allow the provider to identify the particular records sought;   (c) allow providers to submit the requested records in an electronic format; and   (d) allow reasonable extensions of the 30-day compliance period for good cause.   (2) If an auditor is conducting an overpayment audit and requires the provider to provide records in a nonelectronic format, the auditor shall reimburse the provider for the cost of providing the records.   (3) (a) For an initial overpayment audit, the department or an auditor may request up to 6 months of records from a provider for claims paid by the medicaid program up to 3 years before the request was made.   (b) If the department or an auditor demonstrates a significant error rate, the department or the auditor with the department's approval may request additional records related to the issue under review for purposes of a followup audit.   (c) The 3-year limitation in subsection (3)(a) does not apply to a record request by the department or auditor for purposes of a followup audit but does apply to such a request by a recovery audit contractor.   (4) The department or an auditor may not request records or perform an overpayment audit regarding services that were provided outside the period of time for which providers are required by applicable law to retain records for purposes of the medicaid program.   (5) Except in cases of suspected fraud or criminal conduct, the department or an auditor may not schedule an onsite overpayment audit without first providing written notice at least 10 days in advance of the onsite audit. The department or auditor shall make a good faith effort to establish a mutually agreed-upon date and time for the onsite audit.   History: En. Sec. 2, Ch. 82, L. 2017.
MT Code § 53-6-1403 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1403. Extrapolation and statistical sampling prohibited -- exceptions

  53-6-1403. Extrapolation and statistical sampling prohibited -- exceptions. (1) Except as provided in subsection (2):   (a) in conducting an initial overpayment audit, the department or an auditor may not use statistical sampling extrapolation for automated reviews and may not rely on extrapolation to determine or support the amount of an overpayment determination; and   (b) an overpayment determination must be based on and supported by evidence of an overpayment for each claim.   (2) In an overpayment audit of a high-risk provider or a followup audit of any provider, the department or an auditor may use statistical sampling extrapolation for an automated review or may rely on extrapolation to determine or support the amount of an overpayment determination.   (3) The department or an auditor may use data analysis techniques to identify claims that are most likely to contain overpayments for purposes of selecting providers or claims for overpayment audits.   History: En. Sec. 3, Ch. 82, L. 2017.
MT Code § 53-6-1404 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1404. Peer review of overpayment findings

  53-6-1404. Peer review of overpayment findings. (1) (a) A provider's request for an administrative review of an overpayment determination may include a request for peer review of any clinical or professional judgment upon which the overpayment determination relies. A clinical or professional judgment includes but is not limited to any clinical or professional judgment upon which the provider's evaluation, treatment, records, coding, or billing is based.   (b) The provider's peer review request must identify each clinical or professional judgment to be reviewed and include a statement of the provider's opinion regarding the identified clinical or professional judgment.   (2) If a provider requests peer review, the department shall obtain and consider as part of its administrative review a peer review of each clinical or professional judgment upon which the overpayment determination relied. The department shall mail a copy of the peer review to the provider within 10 days of receipt. The department may not issue its administrative review determination or demand or collect repayment of the alleged overpayment until the department has obtained and considered the peer review.   (3) If at any time during an administrative review, appeal, or other legal proceedings regarding an overpayment determination the department relies on a clinical or professional judgment not identified in the initial notice of overpayment determination and for which a peer review was not previously requested, obtained, or considered, the provider may request in writing that peer review be conducted in accordance with this section. The proceedings must be suspended or stayed until the department has obtained, considered, and responded in writing to the peer review.   History: En. Sec. 4, Ch. 82, L. 2017.
MT Code § 53-6-1405 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1405. Audit completion -- notice of overpayment determination -- opportunity to resubmit claim

  53-6-1405. Audit completion -- notice of overpayment determination -- opportunity to resubmit claim. (1) The department or an auditor shall conclude an overpayment audit and notify the provider in writing of the audit results, including any overpayment determination, within 90 days of:   (a) the receipt of all records requested in the department's or the auditor's initial record request;   (b) a determination regarding fraud in cases in which the department investigates a credible allegation of fraud; or   (c) the conclusion of an investigation and any related enforcement proceedings if a government agency or entity other than the department is conducting a civil fraud or criminal investigation of the provider and the government agency or entity conducting the investigation determines and notifies the department in writing that providing earlier notification would interfere with or jeopardize the investigation, recovery of a fraudulent overpayment, or criminal prosecution.   (2) A notice of overpayment determination, including any notice of audit results under subsection (1) that includes a notice of overpayment determination, must include a detailed explanation of the overpayment determination, including at a minimum:   (a) a description of the overpayment;   (b) the dollar value of the overpayment;   (c) the specific reason for the overpayment determination;   (d) the specific medical criteria and any clinical and professional judgment upon which the determination is based;   (e) in cases in which an overpayment resulted from incorrect billing rather than a lack of medical necessity or failure to provide the services or items in accordance with applicable requirements, a statement that the provider may submit a new claim or claim adjustment as provided in 53-6-111;   (f) the action to be taken by the department;   (g) an explanation of any action required of the provider; and   (h) an explanation of the provider's right to appeal.   History: En. Sec. 5, Ch. 82, L. 2017.
MT Code § 53-6-1406 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1406. Publication of audit results

  53-6-1406. Publication of audit results. At least once a year the department shall publish and make accessible on its website the following information regarding all medicaid overpayment audits:   (1) the number and type of issues reviewed;   (2) the number of medical and other records requested from providers;   (3) the number of audits conducted by provider type;   (4) the number and aggregate dollar amounts of:   (a) overpayments identified;   (b) overpayments collected; and   (c) underpayments identified;   (5) the duration of audits from initiation to completion;   (6) the number of overpayment determinations and the reversal rates of those determinations at each stage of the informal and formal appeal process;   (7) the number of informal and formal appeals filed by providers, categorized by disposition status; and   (8) the auditor's compensation structure and total dollar amount of compensation for underpayments and overpayments.   History: En. Sec. 6, Ch. 82, L. 2017.
MT Code § 53-6-1407 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1407. Audit education and training

  53-6-1407. Audit education and training. In order to carry out the requirements of 53-6-160(6) and to reduce claims errors, the department shall provide:   (1) educational and training programs for providers at least twice a year to discuss a summary of audit results, common issues and problems, mistakes identified through audits, and opportunities for improvement in provider performance related to claims billings and documentation; and   (2) information on the department's website regarding recurring audit issues, including at a minimum a description of each recurring audit issue, the types of providers affected, the review period in which the audit issues occurred, and any applicable department policy or rule related to the issue.   History: En. Sec. 7, Ch. 82, L. 2017.
MT Code § 53-6-1408 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1408. Applicability to auditor -- scope

  53-6-1408. Applicability to auditor -- scope. (1) An auditor performing or participating in an overpayment audit, overpayment determination, or related activity is subject to the same laws and regulations that would apply to the department in carrying out the same functions.   (2) This part does not apply to the medicaid fraud control unit provided for in 53-6-156 but apply to an overpayment audit, overpayment determination, or related activity by the department or an auditor that is based on or arises out of a medicaid fraud control unit investigation or referral.   History: En. Sec. 8, Ch. 82, L. 2017.
MT Code § 53-6-1409 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1409. Auditor evaluation hearings -- adoption of rules

  53-6-1409. Auditor evaluation hearings -- adoption of rules. At least once a year, the department shall conduct auditor evaluation hearings to identify issues, recommend or require corrective actions, and provide for ongoing and future evaluation of auditor performance. With input from providers, including comments gathered at the auditor evaluation hearings, the department shall adopt rules for:   (1) appropriate and inappropriate conduct and determinations by auditors; and   (2) penalties and sanctions for inappropriate conduct and determinations.   History: En. Sec. 9, Ch. 82, L. 2017.
MT Code § 53-6-1410 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 14. Medicaid Overpayment Audits|53-6-1410. Absorption of costs

  53-6-1410. Absorption of costs. Any cost incurred by the department of public health and human services in implementing 53-6-111 and this part must be absorbed into the department's existing budget.   History: En. Sec. 10, Ch. 82, L. 2017.
MT Code § 53-6-2101 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 21. Children's Mental Health Services Pilot Project -- Youth Outcome Improvement (Terminated)|53-6-2101. Terminated

  53-6-2101. Terminated. Sec. 7, Ch. 265, L. 2015.   History: En. Sec. 1, Ch. 265, L. 2015.
MT Code § 53-6-2102 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 21. Children's Mental Health Services Pilot Project -- Youth Outcome Improvement (Terminated)|53-6-2102. Terminated

  53-6-2102. Terminated. Sec. 7, Ch. 265, L. 2015.   History: En. Sec. 2, Ch. 265, L. 2015.
MT Code § 53-6-2103 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 6. Health Care Services|Part 21. Children's Mental Health Services Pilot Project -- Youth Outcome Improvement (Terminated)|53-6-2103. Terminated

  53-6-2103. Terminated. Sec. 7, Ch. 265, L. 2015.   History: En. Sec. 3, Ch. 265, L. 2015.
MT Code § 53-7-102 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-102. Powers and duties of department

  53-7-102. Powers and duties of department. The department:   (1) shall adopt rules necessary for the administration of this part. Rules adopted may include but are not limited to the provision of services, individual service plans, eligibility for services, application, service goals and design, quality of services, provider relationships, program standards, program staffing, staff training, provider accounting procedures, confidential information, recipient grievance procedures, hearings, and definitions necessary to carry out this part.   (2) may take any other action that it determines necessary or appropriate to carry out the purposes of this part;   (3) may cooperate with other departments and agencies and institutions, both public and private, in providing for vocational rehabilitation of persons with disabilities, in studying the problems involved in vocational rehabilitation, and in establishing, developing, and providing programs, facilities, and services;   (4) may conduct research and compile statistics relating to the vocational rehabilitation of persons with disabilities; and   (5) may accept and use gifts to carry out this part.   History: En. Sec. 3, Ch. 74, L. 1947; amd. Sec. 3, Ch. 53, L. 1961; amd. Sec. 12, Ch. 93, L. 1969; Sec. 41-803, R.C.M. 1947; amd. and redes. 71-1802 by Sec. 11, Ch. 121, L. 1974; R.C.M. 1947, 71-2102; amd. Sec. 2, Ch. 396, L. 1989; amd. Sec. 54, Ch. 472, L. 1997.
MT Code § 53-7-103 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-103. Department to cooperate with federal government

  53-7-103. Department to cooperate with federal government. The department shall cooperate, pursuant to agreements with the federal government, in carrying out the purposes of the federal Rehabilitation Act of 1973 (29 U.S.C. 701, et seq.), as may be amended, and may adopt methods of administration as required by the federal government for state participation in programs funded under the federal act.   History: En. Sec. 5, Ch. 74, L. 1947; amd. Sec. 2, Ch. 218, L. 1959; amd. Sec. 5, Ch. 53, L. 1961; Sec. 41-805, R.C.M. 1947; amd. and redes. 71-1803 by Sec. 12, Ch. 121, L. 1974; R.C.M. 1947, 71-2103; amd. Sec. 3, Ch. 396, L. 1989.
MT Code § 53-7-104 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-104. Repealed

  53-7-104. Repealed. Sec. 16, Ch. 396, L. 1989.   History: En. Sec. 6, Ch. 74, L. 1947; amd. Sec. 3, Ch. 218, L. 1959; Sec. 41-806, R.C.M. 1947; amd. and redes. 71-1804 by Sec. 13, Ch. 121, L. 1974; R.C.M. 1947, 71-2104.
MT Code § 53-7-105 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-105. Eligibility

  53-7-105. Eligibility. A person with a disability is eligible for vocational rehabilitation services if the department, after full investigation, determines that the person may become employable or achieve accepted vocational objectives through the provision of vocational rehabilitation services that are made available as provided for in 53-7-108.   History: En. Sec. 8, Ch. 74, L. 1947; amd. Sec. 3, Ch. 192, L. 1971; Sec. 41-808, R.C.M. 1947; amd. and redes. 71-1805 by Sec. 14, Ch. 121, L. 1974; R.C.M. 1947, 71-2105; amd. Sec. 1, Ch. 55, L. 1981; amd. Sec. 4, Ch. 396, L. 1989; amd. Sec. 55, Ch. 472, L. 1997.
MT Code § 53-7-106 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-106. Hearings

  53-7-106. Hearings. A person applying for or receiving vocational rehabilitation services who is aggrieved by any action or inaction of the department is entitled to a fair hearing in accordance with the rules adopted by the department.   History: En. Sec. 10, Ch. 74, L. 1947; amd. Sec. 4, Ch. 192, L. 1971; Sec. 41-810, R.C.M. 1947; amd. and redes. 71-1806 by Sec. 15, Ch. 121, L. 1974; R.C.M. 1947, 71-2106; amd. Sec. 5, Ch. 396, L. 1989.
MT Code § 53-7-107 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-107. Repealed

  53-7-107. Repealed. Sec. 1, Ch. 32, L. 1987.   History: En. Sec. 12, Ch. 74, L. 1947; Sec. 41-812, R.C.M. 1947; amd. and redes. 71-1807 by Sec. 16, Ch. 121, L. 1974; R.C.M. 1947, 71-2107.
MT Code § 53-7-108 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-108. Provision of services -- financial responsibility for services

  53-7-108. Provision of services -- financial responsibility for services. (1) The department, in accord with this part and the federal Rehabilitation Act of 1973 (29 U.S.C. 701, et seq.), as may be amended, may provide to persons determined eligible under 53-7-105 any vocational rehabilitation services listed in 53-7-101 that are determined by the department to be appropriate and necessary for the person's vocational rehabilitation.   (2) The following vocational rehabilitation services are available without cost to an eligible person:   (a) counseling and guidance;   (b) diagnostic evaluation; and   (c) placement.   (3) In addition to the services listed in subsection (2), the department may pay the cost of other vocational rehabilitation services for an eligible person to the extent that the department determines that the person is without sufficient financial resources to pay the cost of such services.   (4) The department may in its discretion provide maintenance payments to a recipient of vocational rehabilitation services if the department determines that the recipient is without sufficient financial resources to:   (a) obtain basic necessities at a level the department determines is appropriate; and   (b) pay the cost of vocational rehabilitation services to be provided to the person.   History: En. Sec. 6, Ch. 396, L. 1989.
MT Code § 53-7-109 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 1. General Vocational Rehabilitation|53-7-109. Administration of vocational rehabilitation programs -- applicability

  53-7-109. Administration of vocational rehabilitation programs -- applicability. (1) Those divisions of the department that have programs for the provision of vocational rehabilitation services may share administrative personnel, operations, and policies in order to ensure uniform administration necessary under the federal Rehabilitation Act of 1973, 29 U.S.C. 701, et seq., as may be amended.   (2) This section applies to all programs and services in Title 53, chapter 7, administered by the department with funds provided under the federal Rehabilitation Act of 1973, 29 U.S.C. 701, et seq., as may be amended.   History: En. Sec. 14, Ch. 396, L. 1989; amd. Sec. 65, Ch. 130, L. 2005.
MT Code § 53-7-201 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 2. Sheltered Workshops|53-7-201. Legislative findings and purpose

  53-7-201. Legislative findings and purpose. (1) The purpose of this part is to encourage the development and improvement of supervised work programs and support services for persons with severe disabilities.   (2) Supervised work programs and support services should be available to provide persons with severe disabilities the skills and means by which they may lead socially and vocationally productive lives so they can be integrated into society.   (3) The state may encourage the establishment of and provide funding for supervised work programs and support services for persons with severe disabilities.   History: En. Sec. 1, Ch. 322, L. 1973; R.C.M. 1947, 41-816; amd. Sec. 1, Ch. 267, L. 1989.
MT Code § 53-7-202 (2021)
2021 Montana Code Annotated|Title 53. Social Services and Institutions|Chapter 7. Vocational Rehabilitation|Part 2. Sheltered Workshops|53-7-202. Definitions

  53-7-202. Definitions. (1) "Department" means the department of public health and human services.   (2) "Severe disability" means a severe physical or mental impairment that seriously limits a person's functional capacities in respect to obtaining employment.   (3) "Sheltered employment" means a recognized program of rehabilitation, remunerative employment, or other occupational rehabilitating activity of an educational or therapeutic nature provided by a nonprofit sheltered workshop provider. Sheltered employment includes job skills and social skills training and remunerative employment.   (4) "Supervised work program" means a program providing guidance in learning and achieving the requirements of job performance through work activity, sheltered employment, and supported employment.   (5) "Support services" means continuous or periodic job skills training provided to a person at a worksite to enable the person to perform work. Support services also include services away from the worksite that are necessary to allow a person with a severe disability to participate in a supervised work program, such as transportation, direction and assistance in functional skills, and counseling for family members.   (6) "Supported employment" means competitive work in an integrated work setting for a person with a severe disability who is in need of assistance in order to become employed or remain employed. Supported employment includes assessment, preplacement preparation, job development, job placement, job skills training, and support services.   (7) "Work activity" means therapeutic work-related activities provided by a nonprofit work activity center provider to persons whose physical or mental impairment is so severe as to make their productive capacity inconsequential. Therapeutic work-related activities include training in basic skills of living and any purposeful activity so long as work or production is not the main purpose.   History: En. Sec. 2, Ch. 322, L. 1973; amd. Sec. 1, Ch. 333, L. 1974; amd. Sec. 10, Ch. 37, L. 1977; R.C.M. 1947, 41-817; amd. Sec. 2, Ch. 267, L. 1989; amd. Sec. 460, Ch. 546, L. 1995.