reglab/statecodes huggingface dataset:
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 4. Children's Services › Part 11. Healthy Montana Kids Plan › 53-4-1103. Definitions

53-4-1103. Definitions.
For purposes of part 10 and this part, the following definitions apply:
(1) "Comprehensive" means health insurance having benefits at least as extensive as those provided under the children's health insurance program.
(2) "Department" means the department of public health and human services provided for in 2-15-2201.
(3) "Enrollee" means a child who is enrolled or in the process of being enrolled in the plan, including children already enrolled in the programs described in 53-4-1104(2).
(4) (a) "Enrollment partner" means an organization or individual approved by the department to assist in enrolling eligible children in the plan.
(b) An enrollment partner may be but is not limited to:
(i) a licensed health care provider;
(ii) a school;
(iii) a community-based organization; or
(iv) a government agency.
(5) "Habilitative services" means services to help a child maintain, learn, or improve skills and functioning for daily living or to prevent deterioration of skills and that may be offered in a variety of settings. The services include but are not limited to:
(a) physical therapy;
(b) occupational therapy;
(c) speech-language pathology; and
(d) behavioral health treatment, including applied behavior analysis provided by a board-certified behavior analyst.
(6) "Health coverage" means a program administered by the department or a disability insurance plan, referred to in 33-1-207(1)(b), that provides public or private health insurance for children.
(7) "Income" has the meaning provided in 15-30-2337(9)(a).
(8) "Plan" means the healthy Montana kids plan established in 53-4-1104.
(9) "Premium" means the amount of money charged to provide coverage under a public or private health coverage plan.
(10) "Presumptive eligibility" has the meaning provided in 42 CFR 457.355.
History: En. Sec. 3, I.M. No. 155, approved Nov. 4, 2008; amd. Sec. 2, Ch. 399, L. 2017.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 4. Children's Services › Part 11. Healthy Montana Kids Plan › 53-4-1104. Healthy Montana kids plan

53-4-1104. Healthy Montana kids plan.
(1) There is a healthy Montana kids plan that provides comprehensive health coverage to uninsured children who are residents of the state.
(2) The plan includes and coordinates access to health coverage for enrollees in the children's health insurance program and the Montana medicaid program.
(3) The department shall administer the plan.
(4) To the extent permitted by federal law, the department shall use the name of the plan on documents associated with programs described in subsection (2), including but not limited to advertising, brochures, applications, and membership cards.
(5) State funding of the plan is contingent upon the availability of federal matching funds through the children's health insurance program or the Montana medicaid program.
History: En. Sec. 4, I.M. No. 155, approved Nov. 4, 2008.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 4. Children's Services › Part 11. Healthy Montana Kids Plan › 53-4-1105. Rulemaking -- active enrollment -- plan coordination

53-4-1105. Rulemaking -- active enrollment -- plan coordination.
(1) The department shall adopt rules necessary to implement this part, including plan administration, plan enrollment, outreach efforts, and standards of performance to allow enrollment partners to assist in enrolling children in the plan or other health coverage plans administered by the department.
(2) The rules must:
(a) establish a process for identifying and approving enrollment partners;
(b) create and define an active enrollment process;
(c) promote seamless movement between programs described in 53-4-1104(2);
(d) promote accessible enrollment through enrollment partners;
(e) provide, to the extent permitted by law, a single point of access in the department for plan members;
(f) define income for purposes of determining eligibility for children's health coverage programs within the plan;
(g) provide for presumptive eligibility; and
(h) encourage enrollment partners to actively enroll as many eligible, uninsured children as possible in the plan or in an employer-sponsored plan as described in 53-4-1108.
(3) The rules may include the development of enrollment partner training, technical assistance programs, and performance measures.
(4) The rules may provide for an exemption from the active enrollment process based upon an individual showing of:
(a) religious conviction;
(b) private insurance that offers creditable coverage, as defined in 42 U.S.C. 300gg(c), obtained by the parents for the child from a private group or individual health insurance issuer or under a self-funded employer health plan; or
(c) other compelling circumstances.
(5) The rules governing eligibility and premium assistance must be consistent with this part. Rules may include but are not limited to financial standards and criteria for income, nonfinancial criteria, family responsibility, residency, the application process, termination of eligibility, definition of terms, and confidentiality of applicant and recipient information.
History: En. Sec. 5, I.M. No. 155, approved Nov. 4, 2008.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 4. Children's Services › Part 11. Healthy Montana Kids Plan › 53-4-1108. Enrollment in employer-sponsored plans

53-4-1108. Enrollment in employer-sponsored plans.
The department may:
(1) provide premium assistance to families who have access to one or more employer-sponsored comprehensive group health insurance plans in order to provide coverage for eligible children. The premium assistance may not exceed the cost of coverage for that child under the plan.
(2) provide assistance to employers who establish a premium-only health benefits plan under section 125 of the Internal Revenue Code, 26 U.S.C. 125, for the purpose of enrolling children in such a plan and allowing their families to pay any premium with pretax dollars.
History: En. Sec. 6, I.M. No. 155, approved Nov. 4, 2008.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 4. Children's Services › Part 11. Healthy Montana Kids Plan › 53-4-1109. Federal financial participation

53-4-1109. Federal financial participation.
The department shall request any necessary state plan amendments or waivers of federal requirements in order to allow receipt of the maximum available federal funds to facilitate implementation of this part, subject to appropriation of necessary matching state funds.
History: En. Sec. 7, I.M. No. 155, approved Nov. 4, 2008.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 4. Children's Services › Part 11. Healthy Montana Kids Plan › 53-4-1110. Exemption from resource test

53-4-1110. (Temporary) Exemption from resource test.
An otherwise applicable eligibility resource test provided for in 53-6-113(6) and 53-6-131(9) does not apply to plan applicants. (Terminates June 30, 2025, on occurrence of contingency--sec. 48, Ch. 415, L. 2019.)
53-4-1110. (Effective on occurrence of contingency) Exemption from resource test.
An otherwise applicable eligibility resource test provided for in 53-6-113(6) and 53-6-131(8) does not apply to plan applicants.
History: En. Sec. 8, I.M. No. 155, approved Nov. 4, 2008; amd. Sec. 25, Ch. 415, L. 2019; amd. Sec. 1, Ch. 155, L. 2021.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 4. Children's Services › Part 11. Healthy Montana Kids Plan › 53-4-1115. Special revenue account

53-4-1115. Special revenue account.
(1) There is an account in the state special revenue fund to the credit of the department for the purposes provided in subsection (2). There must be paid into the account the amounts collected under 33-2-708(3)(b). Any interest or income derived from the account must be deposited in the account.
(2) Money in the account:
(a) is to be used solely to cover the number of additional enrollees in the plan that exceeds the number of enrollees as of November 4, 2008, within the limits provided in 53-4-1004, 53-6-131, and this part, and to cover the costs of enrollment, including premium assistance, under 53-4-1108(1), and to pay administrative costs associated with expanded eligibility, and to establish and maintain a reserve; and
(b) may be used only to match federal funds available under the children's health insurance program and the Montana medicaid program.
(3) The unexpended balance of an appropriation from the account must remain in the account and may be used only for the purposes stated in subsection (2).
(4) The special revenue account does not affect and is not exclusive of any other sources of funding for the programs described in 53-4-1104(2), including the special revenue account provided for in 53-4-1012.
(5) If the department determines that there is insufficient funding for the purposes of subsection (2), it may reduce eligibility requirements for participants in the children's health insurance program as provided in 53-4-1004(4).
History: En. Sec. 9, I.M. No. 155, approved Nov. 4, 2008.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 5. Adult Services › Part 4. Old-Age Assistance Recovery (Repealed) › 53-5-401. Repealed

53-5-401. Repealed.
Sec. 27, Ch. 492, L. 1995.
History: En. Sec. 11, Part 3, Ch. 82, L. 1937; amd. Sec. 1, Ch. 178, L. 1943; amd. Sec. 1, Ch. 63, L. 1947; amd. Sec. 1, Ch. 234, L. 1953; R.C.M. 1947, 71-412; amd. Sec. 13, Ch. 324, L. 1991.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 5. Adult Services › Part 9. Notice of Medicare Assignments › 53-5-901. Medicare assignments -- notice required

53-5-901. Medicare assignments -- notice required.
(1) A health care provider shall give notice to a medicare patient as to whether or not the provider accepts payment for services on the basis of an assignment, pursuant to section 1842(b)(3)(B)(ii) of the federal Social Security Act, 42 U.S.C. 1395u(b)(3)(B)(ii), the terms of which provide that the full charge for services is the amount of the medicare-approved rate for payment of the applicable service plus any deductible, coinsurance, or copayment required to be paid by the patient.
(2) The notice required under subsection (1) must be posted by each health care provider in a conspicuous area in the provider's place of business.
(3) For purposes of this section, "health care provider" means a person, firm, corporation, association, or institution that provides goods or services subject to reimbursement under the federal medicare program in accordance with Title XVIII of the federal Social Security Act, 42 U.S.C. 1395, et seq.
History: En. Sec. 1, Ch. 306, L. 1989; amd. Sec. 1904, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-102. Repealed

53-6-102. Repealed.
Sec. 8, Ch. 711, L. 1989.
History: En. Sec. 2, Ch. 325, L. 1967; amd. Sec. 1, Ch. 261, L. 1971; R.C.M. 1947, 71-1512(part).
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-103. Repealed

53-6-103. Repealed.
Sec. 5, Ch. 31, Sp. L. November 1993.
History: En. Sec. 1, Ch. 325, L. 1967; amd. Secs. 47 and 48, Ch. 121, L. 1974; R.C.M. 1947, 71-1511(3); amd. Sec. 2, Ch. 711, L. 1989.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-104. Freedom of doctors to treat recipients of medical assistance -- freedom to select doctor

53-6-104. Freedom of doctors to treat recipients of medical assistance -- freedom to select doctor.
(1) The department of public health and human services shall provide for professional freedom of those licensed practitioners who provide medical assistance under this part and provide reasonable freedom of choice to recipients of medical aid to select the vendor or provider of medical care, services, or prescribed drugs.
(2) This section may not be construed to prohibit the department from imposing conditions on the payment of provider services and the receipt of medical assistance, as provided for under 53-6-111 and 53-6-113 through 53-6-116.
History: En. Sec. 4, Ch. 325, L. 1967; R.C.M. 1947, 71-1514; amd. Sec. 1, Ch. 475, L. 1985; amd. Sec. 3, Ch. 711, L. 1989; amd. Sec. 1, Ch. 31, Sp. L. November 1993; amd. Sec. 439, Ch. 546, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-105. Discrimination prohibited

53-6-105. Discrimination prohibited.
No discrimination shall be practiced or asserted against any applicant for or recipient of care and services under this part on the basis of race, color, or national origin, and the furnishing of care and services under this part to any applicant or recipient thereof shall not be delayed or denied on the basis of race, color, or national origin.
History: En. Sec. 16, Ch. 325, L. 1967; R.C.M. 1947, 71-1526.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-106. Health care facility standards -- definitions

53-6-106. Health care facility standards -- definitions.
(1) For purposes of 53-6-106 through 53-6-108, the following definitions apply:
(a) "Department" means the department of public health and human services.
(b) "Health care facility" means a health care facility as defined in 50-5-101 and includes a public health center as defined in 7-34-2102.
(2) The department may enter into agreements with appropriate federal agencies for the purpose of certifying health care facilities for the Montana medicaid program.
(3) The department may adopt rules as necessary to prescribe minimum standards for the maintenance and operation of health care facilities. Standards for the quality of care provided by those facilities receiving reimbursement under the Montana medicaid program must be consistent with those requirements imposed upon health care facilities by Title XIX of the federal Social Security Act, 42 U.S.C. 1396, et seq., as may be amended, and by the implementing regulations contained in Title 42 of the Code of Federal Regulations, as may be amended. The authority to prescribe standards and adopt rules under 53-6-106 through 53-6-108 is in addition to the authority granted to the department pursuant to Title 50, chapter 5.
(4) Standards adopted by the department may include but are not limited to requirements in the following areas: staffing, fire protection, health and safety, food and nutrition, environmental and sanitation, administration, admission policies, patient care planning, training, medication, health services, rehabilitation services, and social services and activities.
History: En. Sec. 4(1) thru (4), Ch. 711, L. 1989; amd. Sec. 12, Ch. 354, L. 1995; amd. Sec. 158, Ch. 418, L. 1995; amd. Sec. 440, Ch. 546, L. 1995; amd. Sec. 17, Ch. 93, L. 1997.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-107. Sanctions -- penalties

53-6-107. Sanctions -- penalties.
(1) The department may suspend, terminate, or refuse to renew an agreement with a health care facility that has failed to meet the requirements for certification for or participation in the Montana medicaid program under 53-6-106 through 53-6-108 or other applicable law. The department may also impose sanctions in the form of denial of medicaid payments for new admissions or other penalties or sanctions, as described in 53-6-111 or Title XIX of the Social Security Act, 42 U.S.C. 1396, et seq., as may be amended, and any implementing federal regulations.
(2) The department may impose a civil monetary penalty, with interest not to exceed 12% a year, for each day that a facility is substantially out of compliance with standards or participation requirements provided by applicable state or federal laws, regulations, or rules, including but not limited to standards adopted by the department under the authority of Title 50, chapter 5, or 53-6-106 through 53-6-108. Penalties must be collected by the department and may be applied to the protection of the health and property of residents of health care facilities that the department finds deficient, including but not limited to payment for the costs of relocation of residents to other facilities, operation of a facility pending correction of deficiencies or closure, and reimbursement of residents for personal funds lost.
(3) The department may appoint temporary management personnel to oversee the operation of the facility and to ensure the health and safety of the facility's residents if there is a need for temporary management because:
(a) an orderly closure of the facility is necessary; or
(b) improvements are being made to bring the facility into compliance with applicable standards.
(4) The department shall, in the case of an emergency, close the facility or transfer residents in the facility to other facilities, or both.
History: En. Sec. 4(5) thru (8), Ch. 711, L. 1989; amd. Sec. 13, Ch. 354, L. 1995; amd. Sec. 159, Ch. 418, L. 1995; amd. Sec. 441, Ch. 546, L. 1995; amd. Sec. 1, Ch. 346, L. 2001.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-108. Rules governing sanctions or remedies

53-6-108. Rules governing sanctions or remedies.
The department shall adopt rules governing the application of sanctions or remedies imposed under 53-6-107, the amounts of any fines, and the severity of each of these sanctions or remedies. The rules must be designed for the imposition of incrementally more severe fines for repeated or uncorrected deficiencies. The civil penalty for violation of the applicable standards imposed by state or federal laws, regulations, or rules may not exceed $10,000 for each day that the deficiency remains uncorrected. A health care facility aggrieved by an action of the department may request a hearing pursuant to Title 2, chapter 4, part 6.
History: En. Sec. 4(9), Ch. 711, L. 1989; amd. Sec. 14, Ch. 354, L. 1995; amd. Sec. 160, Ch. 418, L. 1995; amd. Sec. 442, Ch. 546, L. 1995; amd. Sec. 2, Ch. 346, L. 2001.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-110. Report and recommendations on medicaid funding

53-6-110. Report and recommendations on medicaid funding.
(1) As a part of the information required in 17-7-111, the department of public health and human services shall submit a report concerning medicaid funding for the next biennium. This report must include at least the following elements:
(a) analysis of past and present funding levels for the various categories and types of health services eligible for medicaid reimbursement;
(b) projected increased medicaid funding needs for the next biennium. These projections must identify the effects of projected population growth and demographic patterns on at least the following elements:
(i) trends in unit costs for services, including inflation;
(ii) trends in use of services;
(iii) trends in medicaid recipient levels; and
(iv) the effects of new and projected long-term care facilities and services for which a need has been identified in the state long-term care facilities plan.
(2) As an integral part of the report, the department of public health and human services shall present a recommendation of funding levels for the medicaid program. The recommendation need not be consistent with the state health care facilities plan.
(3) In making its appropriations for medicaid funding, the legislature shall specify the portions of medicaid funding anticipated to be allocated to specific categories and types of health care services.
(4) Beginning November 15 of each year through June 15 of the following year, the department of public health and human services shall provide to the legislative fiscal analyst monthly reports containing estimates of the cost for medicaid services and a budget status report for all department programs. The department shall also provide a fiscal yearend summary of medicaid costs and the department budget status report prior to the first legislative finance committee meeting following the end of the fiscal year. The reports must be presented in a format mutually agreed to by the legislative fiscal analyst and the department. The department shall provide the yearend summaries to the legislature in accordance with 5-11-210.
History: En. Sec. 8, Ch. 329, L. 1983; amd. Sec. 39, Ch. 112, L. 1991; amd. Sec. 35, Ch. 349, L. 1993; (5)En. Sec. 1, Ch. 14, Sp. L. November 1993; amd. Sec. 161, Ch. 418, L. 1995; amd. Sec. 443, Ch. 546, L. 1995; amd. Sec. 238, Ch. 42, L. 1997; amd. Sec. 18, Ch. 93, L. 1997; amd. Sec. 1, Ch. 380, L. 2005; amd. Sec. 15, Ch. 120, L. 2013; amd. Sec. 88, Ch. 261, L. 2021; amd. Sec. 8, Ch. 477, L. 2021.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-112. Department to print and distribute copies of part and certain forms

53-6-112. Department to print and distribute copies of part and certain forms.
The department shall have printed and shall distribute copies of this part to all local offices of public assistance and shall prescribe the form of and print and supply to the local offices of public assistance blanks of applications, reports, and other forms that may be necessary in relation to medical assistance.
History: En. Sec. 1, Ch. 325, L. 1967; amd. Secs. 47 and 48, Ch. 121, L. 1974; R.C.M. 1947, 71-1511(4); amd. Sec. 445, Ch. 546, L. 1995; amd. Sec. 35, Ch. 571, L. 2001.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-114. Rules of department binding

53-6-114. Rules of department binding.
All rules of the department made under this part are binding upon the local offices of public assistance.
History: En. Sec. 1, Ch. 325, L. 1967; amd. Secs. 47 and 48, Ch. 121, L. 1974; R.C.M. 1947, 71-1511(5); amd. Sec. 447, Ch. 546, L. 1995; amd. Sec. 36, Ch. 571, L. 2001.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-115. Contracts with other agencies

53-6-115. Contracts with other agencies.
The department of public health and human services may by suitable rules provide for contracting with any state or private agency for processing and payment of claims under the program of medical assistance, and the department may contract with one or more private or state agencies to provide any or all of the enumerated medical services.
History: En. Sec. 5, Ch. 325, L. 1967; amd. Sec. 49, Ch. 121, L. 1974; R.C.M. 1947, 71-1515; amd. Sec. 448, Ch. 546, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-116. Medicaid managed care -- capitated health care

53-6-116. Medicaid managed care -- capitated health care.
(1) The department of public health and human services, in its discretion, may develop managed care and capitated health care systems for medicaid recipients.
(2) The department may contract with one or more persons for the management of comprehensive physical health services and the management of comprehensive mental health services for medicaid recipients. The department may contract for the provision of these services by means of a fixed monetary or capitated amount for each recipient.
(3) A managed care system is a program organized to serve the medical needs of medicaid recipients in an efficient and cost-effective manner by managing the receipt of medical services for a geographical or otherwise defined population of recipients through appropriate health care professionals.
(4) The provision of medicaid services through managed care and capitated health care systems is not subject to the limitations provided in 53-6-104. The managed care or capitated health care system that is provided to a defined population of recipients may be based on one or more of the medical assistance services provided for in 53-6-101.
(5) The proposed systems, referred to in subsection (1), must be submitted to the legislative finance committee. The legislative finance committee shall review the proposed systems at its next regularly scheduled meeting and shall provide any comments concerning the proposed systems to the department. The department shall provide a copy of any reports made to the legislative finance committee concerning the proposed systems to the legislature in accordance with 5-11-210.
(6) A managed care or capitated health care system, except for a primary care case management service, that requires for implementation a waiver from the centers for medicare and medicaid is subject to the provisions of Title 53, chapter 6, part 7.
History: En. Sec. 1, Ch. 460, L. 1991; amd. Sec. 2, Ch. 31, Sp. L. November 1993; amd. Sec. 449, Ch. 546, L. 1995; amd. Sec. 2, Ch. 466, L. 2001; amd. Sec. 5, Ch. 351, L. 2011; amd. Sec. 89, Ch. 261, L. 2021.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-117. Participation requirements

53-6-117. Participation requirements.
(1) The department of public health and human services may require medicaid recipients to participate in a managed care system.
(2) Recipients who are required by the department to participate in a managed care system shall participate as required in order to remain eligible for medicaid.
(3) The department may require the participation of medicaid recipients in managed care systems based upon geographical, financial, social, medical, and other factors as the department may determine are relevant to the development and efficient management of managed care systems.
History: En. Sec. 2, Ch. 460, L. 1991; amd. Sec. 450, Ch. 546, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-121. Local administration of medical assistance

53-6-121. Local administration of medical assistance.
The local offices of public assistance are charged with the local administration and supervision of medical assistance, including medicaid, subject to the powers, duties, rules, and overall supervision of the department.
History: En. Sec. 1, Ch. 325, L. 1967; amd. Secs. 47 and 48, Ch. 121, L. 1974; R.C.M. 1947, 71-1511(2); amd. Sec. 37, Ch. 571, L. 2001.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-122. Telehealth services -- requirements -- limitations

53-6-122. Telehealth services -- requirements -- limitations.
(1) Providers enrolled in the medicaid program may provide medically necessary services by means of telehealth if the service:
(a) is clinically appropriate for delivery by telehealth as specified by the department by rule or policy;
(b) comports with the guidelines of the applicable medicaid provider manual; and
(c) is not specifically required in the applicable provider manual to be provided in a face-to-face manner.
(2) A provider shall:
(a) ensure an enrollee receiving telehealth services has the same rights to confidentiality and security as provided for traditional office visits;
(b) follow consent and patient information protocols consistent with the protocols followed for in-person visits; and
(c) comply with recordkeeping requirements established by the department by rule.
(3) Telehealth services:
(a) may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication;
(b) may not be provided in a setting or manner not otherwise authorized by law; and
(c) must be reimbursed at the same rate of payment as services delivered in person.
(4) An enrollee's residence is not reimbursable as an enrolled originating site provider.
(5) The department shall adopt rules for the provision of telehealth services, including but not limited to:
(a) billing procedures for enrolled providers;
(b) the services considered clinically appropriate for telehealth purposes;
(c) recordkeeping requirements for providers, including originating site providers; and
(d) other requirements for originating site providers, including allowable provider types, reimbursement rates, and requirements for the secure technology to be used at originating sites.
(6) Nothing in this section may be construed as altering the scope of practice of any enrolled provider delivering services by means of telehealth.
History: En. Sec. 2, Ch. 497, L. 2021.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-124. Definitions

53-6-124. Definitions.
As used in 53-6-125, 53-6-127, and this section, the following definitions apply:
(1) "Conversion factor" means the dollar value that is multiplied by the appropriate relative value unit to calculate a price for a service provided by a physician.
(2) "Department" means the department of public health and human services.
(3) "Medicaid" means the Montana medical assistance program established under Title 53, chapter 6.
(4) "Physician" has the meaning provided in 37-3-102.
(5) "Policy adjuster" means a factor by which the fee determined under 53-6-125 is multiplied to increase the fee paid by medicaid for certain categories of services.
(6) "Relative value unit" means a numerical value assigned in the resource-based relative value scale to each procedure code used to bill for services provided by a physician.
(7) "Resource-based relative value scale" means the medicare resource-based relative value scale contained in the physician's medicare fee schedule adopted by the centers for medicare and medicaid services of the U.S. department of health and human services.
History: En. Sec. 1, Ch. 414, L. 2007; amd. Sec. 1, Ch. 397, L. 2011.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-125. Physician services reimbursement

53-6-125. Physician services reimbursement.
(1) The fee for a covered service provided by a physician under the medicaid program is determined by multiplying the conversion factor times the relative value unit for that service times any applicable policy adjusters.
(2) (a) For fiscal years 2018 and 2019, the conversion factor must be increased, at a minimum, by the same numerical inflation factor calculated in accordance with 20-9-326.
(b) For each subsequent fiscal year, the conversion factor must be increased, at a minimum, by the same percentage increase as the consumer price index for medical care for the previous year, as calculated by the bureau of labor statistics of the United States department of labor.
History: En. Sec. 2, Ch. 414, L. 2007; amd. Sec. 2, Ch. 397, L. 2011; amd. Sec. 6, Ch. 364, L. 2017; amd. Sec. 8, Ch. 393, L. 2019.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-127. Rulemaking -- policy adjusters

53-6-127. Rulemaking -- policy adjusters.
The department may by rule adopt policy adjusters for certain categories of service. A policy adjuster may not be less than 1.
History: En. Sec. 4, Ch. 414, L. 2007.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-132. Application for assistance -- exception

53-6-132. Application for assistance -- exception.
(1) Subject to subsection (2), application for assistance under this part may be made in any local office of public assistance. The application must be presented in the manner and on the form prescribed by the department. All individuals wishing to apply must have the opportunity to do so.
(2) Notwithstanding the provisions of subsection (1), the department may designate an entity other than the local office of public assistance to determine eligibility for medicaid managed care services.
History: En. Sec. 8, Ch. 325, L. 1967; R.C.M. 1947, 71-1518; amd. Sec. 452, Ch. 546, L. 1995; amd. Sec. 9, Ch. 590, L. 1995; amd. Secs. 39, 42, Ch. 465, L. 2001; amd. Sec. 38, Ch. 571, L. 2001.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-133. Eligibility determination

53-6-133. Eligibility determination.
(1) The local office of public assistance shall promptly determine the eligibility of each applicant under this part in accordance with the rules of the department. Each applicant must be informed of the right to a fair hearing and of the confidential nature of the information given. The department, through the local office of public assistance, shall, after the hearing, determine whether or not the applicant is eligible for assistance under this part, and aid must be furnished promptly to eligible persons. Each applicant must receive written notice of the decision concerning the applicant's application, and the right of appeal is secured to the applicant under the procedures of 53-2-606.
(2) The local office of public assistance and the department may accept the federal social security administration's determination of eligibility for supplemental security income, Title XVI of the Social Security Act, as qualifying the eligible individuals to receive medical assistance under this part.
(3) (a) The department shall verify the information provided on an application for medicaid under part 13 or under this part, using data sources allowed under federal law or regulation and Montana department of revenue information as required under subsection (3)(b), to confirm an applicant's eligibility for the program before authorizing payment of benefits under the program.
(b) The department shall request income tax and wage income from the department of revenue as allowed under 15-30-2618 and 15-31-511 to verify the income information provided by applicants who may be eligible for coverage pursuant to 53-6-1304.
(4) The department shall establish by rule the documents to be used to verify that an applicant is a Montana resident. (Subsections (3) and (4) terminate June 30, 2025, on occurrence of contingency--sec. 48, Ch. 415, L. 2019.)
History: En. Sec. 10, Ch. 325, L. 1967; amd. Sec. 1, Ch. 181, L. 1974; amd. Sec. 1, Ch. 327, L. 1977; R.C.M. 1947, 71-1520; amd. Sec. 2, Ch. 310, L. 1989; amd. Sec. 453, Ch. 546, L. 1995; amd. Sec. 39, Ch. 571, L. 2001; amd. Sec. 27, Ch. 415, L. 2019.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-134. Extension of eligibility for medical assistance to persons terminated from section 1931 medicaid program

53-6-134. Extension of eligibility for medical assistance to persons terminated from section 1931 medicaid program.
(1) In providing for the extension of eligibility for medical assistance under subsection (2), the department may provide for health insurance or other health coverage in accordance with subsections 1925(a)(4)(B) and 1925(b)(4)(C) of Title XIX of the Social Security Act, 42 U.S.C. 1396r-6(a)(4)(B) and 42 U.S.C. 1396r-6(b)(4)(C), and may exercise the other options contained in section 1925 of Title XIX of the Social Security Act, 42 U.S.C. 1396r-6, regarding the provision of medical assistance.
(2) In accordance with waivers of federal law that are granted by the secretary of the U.S. department of health and human services, the department of public health and human services may provide extended eligibility for medical assistance for a period of time established by the department by rule for persons receiving section 1931 medicaid benefits, as defined in 53-4-602, who lose eligibility because of increased earned or unearned income to the assistance unit, as that term is defined in the rules of the department, provided that the family's income does not exceed a percentage of the federal poverty level established by the department by rule. The department, in exercising its discretion to establish income standards and duration of extended medical assistance by rule, may consider the amount of funds appropriated by the legislature.
History: En. Sec. 1, Ch. 453, L. 1989; amd. Sec. 28, Ch. 491, L. 1995; amd. Sec. 454, Ch. 546, L. 1995; amd. Sec. 49, Ch. 486, L. 1997; amd. Sec. 40, Ch. 465, L. 2001.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-135. Prohibited reimbursement or coverage

53-6-135. Prohibited reimbursement or coverage.
Pursuant to 50-4-1004, the Montana medicaid program may not reimburse or provide coverage for any medical treatment prohibited in 50-4-1004(1)(a) or (1)(b).
History: En. Sec. 8, Ch. 306, L. 2023.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-140. Account not to be treated as asset for purposes of eligibility

53-6-140. Account not to be treated as asset for purposes of eligibility.
If allowed by federal law, the principal and all interest or other income contained within an account established in accordance with Title 15, chapter 61, may not be treated as an asset of the employee or account holder or as an asset of a dependent of the employee or account holder for the purposes of eligibility for the Montana medicaid program.
History: En. Sec. 9, Ch. 295, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-141. Repealed

53-6-141. Repealed.
Sec. 8, Ch. 711, L. 1989.
History: En. Sec. 7, Ch. 325, L. 1967; amd. Sec. 3, Ch. 261, L. 1971; amd. Sec. 2, Ch. 20, L. 1973; R.C.M. 1947, 71-1517; amd. Sec. 1, Ch. 562, L. 1979; amd. Sec. 112, Ch. 370, L. 1987; amd. Sec. 3, Ch. 310, L. 1989.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-142. Periodic review of assistance

53-6-142. Periodic review of assistance.
All medical assistance cases approved under this part must be reviewed as often as required under the rules of the department of public health and human services.
History: En. Sec. 11, Ch. 325, L. 1967; R.C.M. 1947, 71-1521; amd. Sec. 455, Ch. 546, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-144. Relative's responsibility

53-6-144. Relative's responsibility.
Except as otherwise provided in 53-6-167 through 53-6-169, 53-6-171 through 53-6-189, and the provisions of other parts of this title, the only relatives that may be held responsible for payment of medical assistance under the program are the husband or wife of the individual, the parents of children under 18 years of age, and the parents of blind or disabled persons over 18 years of age.
History: En. Sec. 15, Ch. 325, L. 1967; amd. Sec. 15, Ch. 423, L. 1971; R.C.M. 1947, 71-1525; amd. Sec. 4, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-148. Indian health services federal revenue account

53-6-148. Indian health services federal revenue account.
(1) There is an account in the federal special revenue fund established pursuant to 17-2-102 to be known as the Indian health service federal revenue account.
(2) Funds in the account are statutorily appropriated, as provided in 17-7-502, to the department for medicaid benefits for Indian health services or tribal health services.
History: En. Sec. 3, Ch. 364, L. 2017.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-149. State special revenue fund account -- administration

53-6-149. State special revenue fund account -- administration.
(1) There is a hospital medicaid reimbursement account in the state special revenue fund provided for in 17-2-102.
(2) All money collected under 15-66-102[, except for the money deposited pursuant to 15-66-102(3)(b) into the Montana HELP Act special revenue account provided for in 53-6-1315,] must be deposited in the account.
(3) Money in the account must be used by the department of public health and human services to provide funding [no later than May 5 of each year] for increases in medicaid payments to hospitals and for the costs of collection of the fee and other administrative activities associated with the implementation of increases in the medicaid payments to hospitals. (Bracketed language terminates June 30, 2025, on occurrence of contingency--sec. 48, Ch. 415, L. 2019.)
History: En. Sec. 14, Ch. 390, L. 2003; amd. Sec. 33, Ch. 489, L. 2009; amd. Sec. 28, Ch. 415, L. 2019.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-150. Donated funds

53-6-150. Donated funds.
The department of public health and human services may receive private funds and nonfederal and nonstate public funds for its medical assistance programs. Donated funds must be matched with federal funds whenever possible.
History: En. Sec. 1, Ch. 164, L. 1987; amd. Sec. 457, Ch. 546, L. 1995; amd. Sec. 46, Ch. 422, L. 1997.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-151. Medicaid reserve account

53-6-151. Medicaid reserve account.
There is a medicaid reserve account in the state special revenue fund provided for in 17-2-102. Money in the account must be used by the department for medicaid benefits after June 30, 2011. Any interest or income earned on the account must be deposited in the account. Each calendar quarter through December 31, 2010, the amount recovered under the federal medical assistance percentage hold harmless provision of the American Recovery and Reinvestment Act of 2009, Public Law 111-5, must be transferred to the medicaid reserve account.
History: En. Sec. 34, Ch. 489, L. 2009.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-156. Medicaid fraud control unit

53-6-156. Medicaid fraud control unit.
(1) There is a medicaid fraud control unit in the department of justice. The unit is under the supervision and control of the attorney general and, subject to the availability of appropriated funds, consists of the agents and employees of the department of justice whom the attorney general considers necessary and appropriate, including but not limited to:
(a) persons qualified by education, training, experience, and high professional competence in criminal and civil investigative procedures;
(b) at least one person licensed to practice law in Montana and qualified by education, training, experience, and high professional competence to prosecute crimes; and
(c) auditors and other additional professional and support staff.
(2) The medicaid fraud control unit is a criminal justice agency within the meaning of 44-5-103. Agents designated by the attorney general have peace officer status and authority, including but not limited to search, seizure, and arrest.
History: En. Sec. 2, Ch. 354, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-158. Cooperation of governmental agencies with medicaid fraud control unit

53-6-158. Cooperation of governmental agencies with medicaid fraud control unit.
All local, county, and state departments and agencies shall cooperate with the medicaid fraud control unit and its agents and employees to effectuate the purposes of the unit.
History: En. Sec. 4, Ch. 354, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-159. Permitted disclosure of information obtained in medicaid fraud control unit investigations

53-6-159. Permitted disclosure of information obtained in medicaid fraud control unit investigations.
Records, documents, and other information obtained in the course of an investigation by the medicaid fraud control unit or its agents, employees, or attorneys may be disclosed:
(1) in accordance with the Montana Criminal Justice Information Act of 1979, as provided in Title 44, chapter 5; and
(2) to a medicaid agency for purposes related to administration of the medicaid program.
History: En. Sec. 5, Ch. 354, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-165. Definitions

53-6-165. Definitions.
As used in this part, unless expressly provided otherwise, the following definitions apply:
(1) "Department" means the department of public health and human services provided for in 2-15-2201.
(2) "Financial institution" means any organization in the business of moving, investing, or lending money, dealing in financial instruments, or providing financial services, including but not limited to federally chartered and state-chartered banks, savings and loan associations, and credit unions.
(3) "Recipient" means an individual who has been determined by a medicaid agency to be eligible for medicaid benefits, whether or not the individual has actually received a benefit, or an individual who has received benefits, whether or not that person has been determined to be eligible.
(4) (a) "Recoverable medical assistance" means a payment pursuant to this part, including but not limited to a payment made for items or services provided to and insurance premiums, deductibles, and coinsurance paid on behalf of a recipient who:
(i) during the recipient's lifetime, was an inpatient in a nursing facility, intermediate care facility for the developmentally disabled, or institution for mental disease and, with respect to that institutionalization, the department determined under 53-6-171 that the person was not reasonably expected to be discharged and return home; or
(ii) was at least 55 years of age or younger if allowed by 42 U.S.C. 1396p, as may be amended, when the item or service was provided or when the insurance premium, deductible, or coinsurance was paid.
(b) The term does not include medical assistance for medicare cost sharing or for benefits described in 42 U.S.C. 1396a(a)(10)(E).
(5) "Recovery" means legal action brought for the payment or repayment of recoverable medical assistance or amounts of money paid for other purposes.
History: En. Sec. 1, Ch. 492, L. 1995; amd. Sec. 2, Ch. 403, L. 2003; amd. Sec. 2, Ch. 153, L. 2009.