reglab/statecodes huggingface dataset:
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-166. Period of ineligibility for medical assistance when assets disposed of for less than fair market value -- undue hardship exception -- department to adopt rules

53-6-166. Period of ineligibility for medical assistance when assets disposed of for less than fair market value -- undue hardship exception -- department to adopt rules.
(1) The department shall, in accordance with 42 U.S.C. 1396p, as may be amended, and implementing federal regulations and policies, impose upon an applicant or recipient a period of ineligibility for medical assistance under this part when the applicant or recipient or the spouse of either directly or indirectly disposes of any assets for less than fair market value during the applicable 3-year, 5-year, or other period provided by 42 U.S.C. 1396p, as may be amended, or by other federal law.
(2) A period of ineligibility for medical assistance may not be imposed upon an applicant or recipient under this section to the extent that the department determines, in accordance with procedures specified by department rule, that the denial of eligibility would cause an undue hardship as defined by department rule.
(3) The department shall adopt rules that are consistent with 42 U.S.C. 1396p, as may be amended, and that implement federal regulations and policies to implement this section. The rules adopted under this section must include but are not limited to rules addressing the following:
(a) a description of the circumstances considered to constitute an undue hardship;
(b) the procedures by which an individual may seek an undue hardship exception;
(c) the persons entitled to an undue hardship exception; and
(d) notice and opportunity for a hearing regarding imposition of a period of ineligibility or denial of an undue hardship exception.
(4) Nothing in 53-6-143, 53-6-144, 53-6-165, 53-6-167 through 53-6-169, 53-6-171 through 53-6-189, or this section is intended to prohibit the department from adopting rules consistent with federal law that provide for a period of ineligibility for public assistance programs other than medical assistance when an applicant or recipient directly or indirectly disposes of assets for less than fair market value.
History: En. Sec. 2, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-168. Payment of certain funds of deceased recipient to department

53-6-168. Payment of certain funds of deceased recipient to department.
(1) (a) A nursing facility, a financial institution, or a person holding personal funds of a deceased nursing facility resident who received medicaid benefits at any time shall, within 30 days following the resident's death, pay those funds to the department.
(b) A nursing facility may satisfy a debt owed by the deceased resident to the facility from the deceased resident's personal funds that are held by the nursing facility and that would have been payable to the facility from the resident's funds. The facility shall pay the remaining funds to the department as required by this section.
(c) Funds paid to the department under this section are not considered to be property of the deceased resident's estate, and 53-6-167 does not apply to recovery of the funds by the department.
(2) For purposes of this section, a nursing facility is holding personal funds of a resident if the facility:
(a) maintains possession of the funds in the facility; or
(b) as the recipient's trustee or representative, has deposited the resident's funds in an individual or shared account in a financial institution.
(3) The department shall apply any funds received under this section proportionately to the federal and state shares of recoverable medical assistance and shall pay any remaining amount to a person entitled by law to the funds.
History: En. Sec. 6, Ch. 492, L. 1995; amd. Sec. 4, Ch. 153, L. 2009.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-169. Payment of excess burial funds or assets to department

53-6-169. Payment of excess burial funds or assets to department.
(1) After the death of a person who at any time received medicaid benefits, a mortician, funeral director, or other person, including but not limited to the decedent's spouse, heir, devisee, or personal representative, who holds funds or other property in excess of $5,000 in value that was specifically designated and set aside for paying for the disposition of the decedent's remains and for related expenses shall, after paying for the disposition and related expenses, pay all remaining funds to the department within 30 days following the burial, cremation, or other final disposition of the decedent's remains. The funds must be paid to the department regardless of any provision in a written contract, trust, or other agreement entered into on or after July 1, 1995, directing a different disposition of the funds. Funds paid to the department under this section are not considered to be property of the decedent's estate, and 53-6-167 does not apply to recovery of the funds by the department.
(2) The department shall apply any funds received under this section proportionately to the federal and state shares of recoverable medical assistance and shall pay any remaining amount to a person entitled by law to the funds.
History: En. Sec. 7, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-171. Department lien upon real property of certain medicaid recipients -- conditions

53-6-171. Department lien upon real property of certain medicaid recipients -- conditions.
(1) Following notice and opportunity for hearing as provided in 53-6-172, the department shall impose a lien upon the real property, including the home, of an institutionalized recipient of recoverable medical assistance to secure the assets of the recipient for recovery of medical assistance paid on behalf of the recipient prior to, on, or after the imposition of the lien if:
(a) the recipient has been admitted to a nursing facility, an intermediate care facility for the developmentally disabled, or an institution for mental disease;
(b) the property upon which a lien is being imposed is the recipient's home and the home is not lawfully resided in by:
(i) the recipient's spouse;
(ii) the recipient's child who is under 21 years of age, blind, or permanently and totally disabled; or
(iii) the recipient's sibling who was residing in the recipient's home for a period of at least 18 months immediately prior to the recipient's institutionalization; and
(c) the recipient has been determined by the department, pursuant to subsection (2), to be permanently institutionalized.
(2) A recipient is permanently institutionalized for purposes of subsection (1)(c) if the department determines that the recipient cannot reasonably be expected to be discharged from the facility and to return home. There is a rebuttable presumption that the recipient cannot reasonably be expected to be discharged from the facility and return home if the recipient or a representative of the recipient declares that there is no intent to return home or if the recipient has been institutionalized for 6 months or longer without a discharge plan. The recipient's institutionalization for a period of 6 months or longer without a discharge plan does not give rise to the presumption if the facility was required by law to adopt a discharge plan but failed to do so. A recipient or a recipient's representative who alleges that there is a reasonable expectation of discharge from the facility and a return home has the burden of demonstrating the reasonable expectation. The reasonable expectation must be established based upon medical evidence and medical opinion. A declaration by the recipient or a recipient's representative that the recipient intends to be discharged from the facility and to return home is not alone sufficient to establish that there is a reasonable expectation of discharge from the facility and a return home.
(3) For purposes of this section, real property of a recipient includes any interest in real property that may be subject to a judgment lien.
History: En. Sec. 8, Ch. 492, L. 1995; amd. Sec. 3, Ch. 403, L. 2003.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-172. Notice of intent to impose lien -- opportunity for hearing

53-6-172. Notice of intent to impose lien -- opportunity for hearing.
Before imposing a lien under 53-6-171, the department shall provide the recipient 30 days' written notice of its determination under 53-6-171(1)(c), of its intent to impose a lien, and of an opportunity for a hearing pursuant to the department's hearing procedures under Title 2, chapter 4, part 6.
History: En. Sec. 9, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-173. Contents of lien document -- scope of obligation secured

53-6-173. Contents of lien document -- scope of obligation secured.
(1) The lien must contain the name and address of the recipient who owns an interest in the property, a legal description of the property, and an address and telephone number of the office or representative of the department who can provide more information about the lien. The lien applies only to the property described in the lien.
(2) The lien need not be executed by or on behalf of the medicaid recipient, but it must be executed by an authorized agent or employee of the department. The execution must be acknowledged as provided in 70-21-203.
(3) The lien need not state the specific amount of medical assistance repayment owed. The lien is sufficient to secure repayment of past, current, and future recoverable medical assistance if the lien states that:
(a) the lien is imposed under 53-6-171 through 53-6-188 to secure the described property for recovery of medical assistance paid on behalf of the recipient prior to, on, and after the date of the lien; and
(b) the amount paid for recoverable medical assistance is due upon sale, transfer, or exchange of any right, title, or interest of the recipient in the property or upon the recipient's death.
History: En. Sec. 10, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-174. Filing of lien -- effect of filing -- priority -- renewal -- dissolution of lien

53-6-174. Filing of lien -- effect of filing -- priority -- renewal -- dissolution of lien.
(1) The lien must be filed in the office of the clerk and recorder in the county in which the real property is located.
(2) Filing of the lien constitutes legal notice of the lien to all persons, including subsequent purchasers, encumbrancers, mortgagees, and other lienholders. Upon filing, the lien is prior to any earlier unrecorded interest or claim and is prior to any subsequent interest or claim, whether or not recorded. The lien is subject to any unpaid property taxes, any prior recorded mortgage, or any other prior recorded encumbrance, interest, or claim. For purposes of recovery under 53-6-171 through 53-6-188, a sale, transfer, or exchange of the property by the recipient is considered a relinquishment of any homestead exemption under 70-32-201 and 70-32-202 of the recipient in the property subject to the lien.
(3) Except as provided in 53-6-171 through 53-6-188, the lien has the effect of a judgment lien when the lien is filed. For purposes of provisions of state laws relating to judgment liens, the department is considered the judgment creditor and the recipient or the recipient's spouse or successor in interest is considered the judgment debtor.
(4) After filing, the lien remains effective for a period of 6 years unless earlier satisfied, released, or dissolved. The department may renew a lien for one or more additional 6-year periods.
(5) If the recipient is discharged from the facility and returns home, the lien dissolves and is no longer effective unless a new lien is later imposed in accordance with 53-6-171 through 53-6-188. Following the recipient's discharge and return home, the department shall upon written request file a release of lien in the clerk and recorder's office. Dissolution of the lien under this subsection does not preclude the department from recovering under 53-6-167, 53-6-168, or 53-6-169.
(6) If the lien is imposed pursuant to 53-6-171 on the recipient's interest in jointly owned property that is subject to a right of survivorship, upon the recipient's death, the recipient's interest passes to the survivor, subject to the lien imposed pursuant to 53-6-171.
History: En. Sec. 11, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-175. Recovery of medical assistance secured by lien -- application for issuance of writ of execution

53-6-175. Recovery of medical assistance secured by lien -- application for issuance of writ of execution.
(1) After the recipient's death or upon the sale, transfer, or exchange of any right, title, or interest of the recipient in the property, the department may file with the clerk of the district court in the county in which the real property is located an application for issuance of a writ of execution for levy on the real property described in the lien. The levy may be for the amount of recoverable medical assistance paid on behalf of the recipient prior to, on, and after the date of the lien, including amounts paid up to the date of sale of the property, plus interest and costs as provided by law. Costs do not include attorney fees.
(2) The application for the writ must be sworn and must contain the following:
(a) the name of the recipient, a legal description of the real property, and a description of the recipient's interest in the property;
(b) a statement that the department has imposed a lien upon the property under 53-6-171;
(c) a statement that the lien complies with the requirements of 53-6-171 through 53-6-188;
(d) the date upon which the lien was filed and the office in which it was filed;
(e) a description of the sale, transfer, exchange, or other event that entitles the department to recover;
(f) a statement that the lien has not dissolved under 53-6-174(5);
(g) the amount of recoverable medical assistance; the amount of any unreimbursed taxes, insurance costs, maintenance costs, or other costs paid under 53-6-186; and, if applicable, a statement that additional amounts may be paid up to the time that the property is sold in satisfaction of the lien;
(h) a statement that the total amount due has not been paid as of the date of the application for the writ;
(i) a statement that recovery is not prohibited by this section;
(j) the names and addresses of all persons who have a recorded interest in the property, including a recipient or recipient's estate, co-owner, purchaser, grantee, encumbrancer, mortgagee, and lienholder; and
(k) a request that a writ of execution be issued for sale of the described property if an action is not filed within the time provided for in 53-6-177.
(3) The filing of an application under this section for a writ of execution is not the filing of a legal action, and the requirements applicable to legal actions do not apply to the application or application proceedings.
History: En. Sec. 12, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-177. Action to challenge issuance of writ of execution

53-6-177. Action to challenge issuance of writ of execution.
A person with a recorded interest in or residing lawfully upon the real property described in an application filed under 53-6-175, including the recipient or recipient's estate or a co-owner, purchaser, grantee, encumbrancer, mortgagee, or lienholder, or any person described in 53-6-171(1)(b) or 53-6-178(2) or (3), may, within 60 days of mailing or service of notice or first publication of notice as provided in 53-6-176, file an action in the district court in the county in which the real property is located challenging the requested issuance of a writ of execution. The court shall determine the validity or invalidity of the department's lien and order appropriate relief, including issuance of the writ or denial of the application for issuance of the writ.
History: En. Sec. 14, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-178. Department right of recovery -- limitations

53-6-178. Department right of recovery -- limitations.
(1) Except as provided in 53-6-180, 53-6-182, and this section, the department may collect upon its lien as provided in 53-6-171 through 53-6-188.
(2) The department may not recover upon a lien imposed on the recipient's home under 53-6-171 while the recipient's sibling or child who has resided lawfully and continuously in the home for at least 18 months immediately before the recipient's institutionalization continues to lawfully reside in the home. This subsection does not preclude the department from recovering under 53-6-167, 53-6-168, or 53-6-169.
(3) The department may not recover on a lien imposed under 53-6-171 while there is a surviving spouse of the recipient or while there is a surviving child of the recipient who is under 21 years of age, blind, or permanently and totally disabled. This subsection does not preclude the department from later recovery in accordance with 53-6-181.
History: En. Sec. 15, Ch. 492, L. 1995; amd. Sec. 5, Ch. 153, L. 2009.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-179. Payment of amount due -- periodic payments -- substitute security

53-6-179. Payment of amount due -- periodic payments -- substitute security.
(1) If the total amount due to the department to satisfy a lien imposed under 53-6-171 through 53-6-188 is paid, the department may not file an application under 53-6-175, shall withdraw its application if the application has already been filed, or shall instruct the sheriff to cancel the sale proceedings.
(2) In lieu of applying for a writ of execution, the department may agree with the heirs or devisees of the recipient to accept periodic payments for the repayment of recoverable medical assistance or may agree with the recipient's surviving spouse to accept substitute security and partial payment. The department may agree to periodic payments or substitute security if the terms of agreement, including security for repayment, are acceptable to the department and if the agreement does not reduce the amount due or the likelihood of recovering the amount due. The department may delay filing an application for issuance of a writ of execution for purposes of conducting negotiations for an agreement in lieu of execution.
History: En. Sec. 16, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-180. Waiver of recovery in cases of undue hardship -- rulemaking

53-6-180. Waiver of recovery in cases of undue hardship -- rulemaking.
(1) (a) A person with a recorded interest in real property subject to a lien under 53-6-171 through 53-6-188 or any other interested person may apply to the department, in accordance with procedures established by department rule, for a waiver of recovery because of undue hardship. The department shall waive its recovery under this section, in whole or in part, if it determines that recovery would result in undue hardship as defined by department rule.
(b) The department shall adopt rules, consistent with 42 U.S.C. 1396p, as may be amended, and implementing federal regulations and policies, establishing procedures and criteria for granting undue hardship exceptions under this section. The rules must include but are not limited to rules addressing the following:
(i) a description of the circumstances considered to constitute an undue hardship;
(ii) the procedures by which an individual may seek an undue hardship exception;
(iii) the persons entitled to an undue hardship exception; and
(iv) whether an exception is partial or temporary and the circumstances under which a partial or temporary exception may be granted.
(c) A person aggrieved by a department determination on an application for an undue hardship exception may assert a claim of entitlement to an undue hardship exception in an action filed under 53-6-177 to challenge issuance of the writ. If a person claims entitlement to an undue hardship exception as part of that action, the court shall make a determination on the undue hardship claim in accordance with the department's rules adopted pursuant to this section. Department denial of all or any part of the relief requested in an application for an undue hardship exception under this section may be reviewed by a district court only through filing of an action as provided in this subsection (c). Denial does not grant a right to a contested case hearing or a right to judicial review under the Montana Administrative Procedure Act or the department's rules.
(2) The department may waive recovery of recoverable medical assistance secured by a lien imposed under 53-6-171 if the department determines that recovery would not be cost-effective. In determining whether recovery would be cost-effective, the department may consider but is not limited to consideration of the following factors:
(a) the estimated cost of recovery;
(b) the amount reasonably likely to be recovered;
(c) the likelihood that recovery by the department will cause a person to become eligible for public assistance; and
(d) the importance of the case or the issues in the case and the need for judicial interpretation of issues that may recur with respect to the administration or implementation of 53-6-171 through 53-6-188.
History: En. Sec. 17, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-181. Delay in recovery -- sale subject to lien

53-6-181. Delay in recovery -- sale subject to lien.
(1) If the department is precluded by 53-6-178(2) or (3) from recovery upon a lien imposed under 53-6-171 through 53-6-188, the department shall maintain the lien in place and upon elimination of the condition that precluded recovery, the department may recover under this section. The department may not file an application for issuance of a writ of execution to recover under this subsection more than 3 years after elimination of the last condition that precluded recovery.
(2) If upon sale, transfer, or exchange of property subject to a lien imposed pursuant to 53-6-171 through 53-6-188 the department is precluded by 53-6-178(2) or (3) from recovering upon the lien, the lien remains in effect, subject to renewal as provided in 53-6-174, and the sale, transfer, or exchange is also subject to the lien.
History: En. Sec. 18, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-182. Spouse's limited exemption from lien

53-6-182. Spouse's limited exemption from lien.
(1) Subject to Title 70, chapter 32, a recipient's surviving spouse who owns a home or an interest in a home in which the spouse resides that is subject to a lien imposed under 53-6-171 through 53-6-188 is, upon sale, transfer, or exchange of the home, entitled to an exemption from the department's lien in an amount determined in accordance with this section. The exemption is in the form of:
(a) a partial release of the department's lien if the exemption amount is less than the full amount of the department's lien; or
(b) a full release of the department's lien if the exemption amount is equal to or greater than the full amount of the department's lien.
(2) The amount of the exemption is the lesser of an amount equal to:
(a) the fair market value of the interest in the home that the surviving spouse received from the recipient by distribution or survival; or
(b) $100,000 minus the total fair market value of all of the surviving spouse's assets, other than the interest in the home that the surviving spouse received from the recipient by distribution or survival. For purposes of this section, the surviving spouse's assets do not include personal property that is exempt from execution under Title 25, chapter 13, part 6.
(3) The department may by rule require a surviving spouse to file an application for the exemption and to provide information, documentation, and verification regarding the applicant's assets and the fair market value of assets. The department shall provide the applicant notice of its determination on the application and of the opportunity for a hearing pursuant to Title 2, chapter 4, part 6.
(4) Upon determination by the department that the applicant is entitled to an exemption, the department shall provide to the applicant an appropriate full or partial release in the amount of the exemption.
History: En. Sec. 19, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-183. Issuance of writ of execution by clerk of court

53-6-183. Issuance of writ of execution by clerk of court.
(1) If the requirements of subsection (2) are met, the clerk of court shall issue a writ of execution specifying the property to be levied upon, the amount due as of the date of filing of the application, and a statement that additional amounts may be due up to and through the date of the sale.
(2) The clerk shall issue the writ if:
(a) (i) an action has not been filed under 53-6-177 within 60 days of mailing, service, or first publication of notice, as provided in 53-6-176;
(ii) the department has filed an affidavit meeting the requirements of 53-6-176(4); and
(iii) the department has filed a sworn application containing the statements required by 53-6-175; or
(b) the court has ordered the issuance of the writ in an action under 53-6-177.
History: En. Sec. 20, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-184. Effect of sale -- title acquired

53-6-184. Effect of sale -- title acquired.
The purchaser of property pursuant to a writ of execution issued under 53-6-171 through 53-6-188 acquires the right, title, interest, and claim that the recipient had at the time the lien was imposed, subject only to any right, title, interest, or claim arising from an instrument recorded prior to the department's lien under 53-6-171 and to any unpaid property taxes. The sale is absolute and is not subject to any period of redemption allowed by Title 25, chapter 13, part 8, or other law.
History: En. Sec. 21, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-185. Disposition of sale proceeds -- application of recovered medical assistance

53-6-185. Disposition of sale proceeds -- application of recovered medical assistance.
(1) The proceeds of a sale of property sold pursuant to a writ of execution issued under 53-6-183 must be distributed in the following order:
(a) as satisfaction of any unpaid property taxes and prior recorded interests as described in 53-6-174(2);
(b) as payment of any claims under 53-6-186(3) and (4);
(c) to the department for application to any costs incurred under 53-6-186(1) and (2) or incurred in collection;
(d) to the department for recoverable medical assistance.
(2) The department shall apply any funds received under subsection (1)(d) proportionately to the federal and state shares of recoverable medical assistance.
(3) Any excess funds remaining after application of proceeds to recoverable medical assistance must be paid to the recipient, if living, or otherwise to the recipient's representative or successor in interest.
History: En. Sec. 22, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-186. Action by department or other person to preserve property subject to lien -- recovery of costs

53-6-186. Action by department or other person to preserve property subject to lien -- recovery of costs.
(1) The department may, in its discretion, take any action it considers necessary to prevent waste or loss or to preserve the value of property subject to a lien under 53-6-171 through 53-6-188, including but not limited to the following:
(a) the payment of any unpaid taxes on the property;
(b) the purchase or renewal of insurance coverage on the property and the payment of necessary insurance premiums;
(c) the ordering of and payment for necessary repairs and maintenance on the property; and
(d) if the property is unoccupied, the rental or lease of the property and the application of any receipts first to unpaid property taxes, insurance, and maintenance and repair and, second, any remaining amount toward repayment of recoverable medical assistance.
(2) The department's reasonable costs and expenses to prevent waste or loss or to preserve the value of the property are secured by the lien imposed under 53-6-171 and may be recovered in addition to all other amounts secured by the lien.
(3) A person who, after the institutionalization or death of the recipient and after the institutionalization of the recipient's surviving spouse, if any, paid real property taxes, homeowner's insurance premiums, or reasonable costs of necessary maintenance or repairs on behalf of the recipient or recipient's spouse, with respect to property subject to a lien under 53-6-171 through 53-6-188, has a claim against the proceeds of a sale of the property under writ of execution issued pursuant to 53-6-183 for recovery of any amounts paid for those purposes. The claim must be supported by written documentation that clearly demonstrates the amount of each payment, the purpose of each payment, and the services and items purchased with each payment. A claim for reimbursement made under this subsection is prior to the department's lien imposed under 53-6-171.
(4) The amount of a claim made under subsection (3) must be reduced by:
(a) the amount of any rents and profits from the property paid after the institutionalization or death of the recipient and the institutionalization of the recipient's surviving spouse, if any;
(b) the value of any property that the person with a claim under subsection (3) will receive by distribution or survival from a deceased recipient if the recipient did not leave a surviving spouse; and
(c) the value of any property that the person with a claim under subsection (3) will receive by distribution or survival from the recipient's deceased spouse if the spouse survived the recipient.
History: En. Sec. 23, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-187. Time for filing of application

53-6-187. Time for filing of application.
Except as provided in 53-6-181, the department may not file an application for issuance of a writ of execution to recover upon a lien imposed under 53-6-171 through 53-6-188 more than 3 years after the latest of:
(1) a sale, transfer, or exchange of any right, title, or interest of the recipient in the property;
(2) the death of the recipient; or
(3) the death of the recipient's surviving spouse.
History: En. Sec. 24, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-188. Coordination of lien with other medical assistance recoveries

53-6-188. Coordination of lien with other medical assistance recoveries.
The existence of a valid lien imposed under 53-6-171 through 53-6-188 or the fact that a lien under 53-6-171 through 53-6-188 is invalid for any reason or is unenforceable under 53-6-180 does not preclude the department from recovering under 53-6-167, 53-6-168, or 53-6-169.
History: En. Sec. 25, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-189. Rulemaking authority

53-6-189. Rulemaking authority.
The department may adopt rules to implement 53-6-143, 53-6-144, 53-6-165 through 53-6-169, and 53-6-171 through 53-6-188. The rules must comply with applicable federal law in 42 U.S.C. 1396, et seq., as may be amended, and applicable implementing regulations and policies.
History: En. Sec. 26, Ch. 492, L. 1995.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-190. Receipt of transferred assets for less than fair market value -- fine

53-6-190. Receipt of transferred assets for less than fair market value -- fine.
(1) A person who receives an asset for less than fair market value from an applicant for or recipient of medical assistance for certain services under this part is subject to a civil fine payable to the department if the department initiates a judicial proceeding and shows by a preponderance of the evidence that:
(a) the asset was transferred to qualify the applicant or recipient for medical assistance for long-term care or home and community-based services;
(b) the transfer resulted in the imposition of a period of ineligibility for medical assistance under 53-6-166;
(c) the department advised the person who received the asset that the transfer would result in a period of ineligibility and the person refused to return the asset to the applicant or recipient; and
(d) the department provided medical assistance to the applicant or recipient during the period of ineligibility because the applicant or recipient received an undue hardship exception under 53-6-166.
(2) A court may impose a civil fine of 100% to 150% of the amount that the department paid for medical assistance for the applicant or recipient during the period of ineligibility that is attributable to the amount transferred to the person receiving the asset, plus the department's court costs and attorney fees.
(3) The department may petition a court to set aside a transfer that meets the requirements in subsection (1) and to require the return of the transferred asset to the applicant or recipient. Action under this subsection must be undertaken using available resources.
(4) All money collected under this section must be distributed to the state general fund and to the United States as required by applicable state and federal laws and regulations.
History: En. Sec. 1, Ch. 362, L. 2013.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-195. Medicaid program for workers with disabilities -- purpose -- eligibility -- participant costs

53-6-195. Medicaid program for workers with disabilities -- purpose -- eligibility -- participant costs.
(1) If appropriations specific for this purpose are provided by the legislature and federal approval of the necessary amendments to the state medicaid plan is secured, the department shall administer a medicaid program that allows individuals with disabilities to participate in the medicaid program if they obtain employment that increases their incomes above eligibility limits. Participants in the program may be required to pay a portion of the costs for participation. The purpose of the program is to support employment for individuals with disabilities by providing medicaid coverage to individuals who would otherwise be ineligible for medicaid due to earnings that exceed the medicaid program's income limits.
(2) The medicaid program provided for under this section must be implemented in accordance with the provisions of 42 U.S.C 1396a(a)(10)(A)(ii)(XIII) and (r)(2).
(3) An employed individual is eligible for the program if the individual:
(a) has a net family income that is less than 250% of the federal poverty level;
(b) would be categorically eligible for medicaid because the individual is disabled as defined under Title XVI of the Social Security Act, 42 U.S.C. 1382c, except that the person has or has had earnings above the level for substantial gainful activity;
(c) has income and resources equal to or below the income and resource limits established by the department by rule, which may be less stringent than the income and resource limits for supplemental security income benefits; and
(d) satisfies all other eligibility criteria established by the department by rule.
(4) The department may establish:
(a) requirements for the employment status of participants, the verification of employment status, and permissible temporary breaks in employment;
(b) requirements, limitations, and definitions pertaining to the income and resources of participants;
(c) only to the extent allowed under 42 U.S.C. 1396o, requirements for payment of premiums, deductions, and cost sharing as a condition for participating in the program.
(5) The department shall, to the extent allowed by appropriations levels and under applicable state and federal law, coordinate the medicaid program provided for under this section with other state and federal programs and resources that promote opportunities for persons with disabilities to retain, regain, and maintain employment.
History: En. Sec. 1, Ch. 452, L. 2009.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-196. Performance-based rulemaking -- privacy exemption

53-6-196. Performance-based rulemaking -- privacy exemption.
(1) Except for rules implementing rate increases or implementing federal law or regulation, the notice of a proposed rule concerning the delivery of medicaid services by the department must include, in addition to the other requirements under this chapter:
(a) a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if such an assessment can be made, the method the department will use to measure whether or not the principal reasons and the rationale for the intended action of the rule, as provided by 2-4-305(6)(b), are successfully achieved, including any data collection methods or metrics if applicable; and
(b) the period over which the intended outcomes will be measured, including any measurement intervals, if applicable.
(2) (a) No later than 1 year after the effective date of the rule subject to subsection (1), the department shall prepare a concise statement of findings evaluating whether, using the data collection or metric identified in the rule proposal, the data collected after the rule's effective date indicated that the rule successfully achieved its intended outcomes. The department shall post the statement of findings on its website.
(b) The department is not under an obligation to report on any other variables that may have impacted the results of the data collection methods or metrics.
(3) The department is exempted from the reporting requirements of subsection (2)(a) to the extent that the requirements would require the publication of confidential information.
(4) The department may only use existing resources to fulfill the mandates of this section.
History: En. Sec. 1, Ch. 453, L. 2015.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 1. Medical Assistance -- Medicaid › 53-6-198. Enhanced rate to increase access to in-state mental health services for high-risk children with multiagency service needs -- reporting requirement -- rulemaking

53-6-198. (Effective on occurrence of contingency -- temporary) Enhanced rate to increase access to in-state mental health services for high-risk children with multiagency service needs -- reporting requirement -- rulemaking.
(1) In an effort to avoid the placement of high-risk children with multiservice agency needs in out-of-state residential treatment facilities, the department shall pay an enhanced medicaid reimbursement rate when an in-state provider of psychiatric residential treatment facility services provides treatment to a child who meets criteria established by the department. The criteria must be related to:
(a) the age of the child; or
(b) the acuity of the child's treatment needs.
(2) (a) For the fiscal year beginning July 1, 2023, the reimbursement rate for psychiatric residential treatment facility services provided to a child meeting the age or acuity criteria established pursuant to this section is the higher of:
(i) 133% of the rate in effect on July 1, 2022, for an in-state provider of the service; or
(ii) the rate adopted by the department for an in-state provider of the service for fiscal year 2024.
(b) The rate provided for in subsection (2)(a) must be increased in each subsequent fiscal year by the provider rate increase approved by the legislature for children's mental health services for that fiscal year.
(3) The department shall annually determine, in consultation with providers of psychiatric residential treatment facility services, the criteria a child must meet for treatment to qualify for the enhanced reimbursement rate. The department shall notify providers of the determination no later than:
(a) May 15 for fiscal year 2024; and
(b) March 30 for subsequent fiscal years.
(4) The department shall adopt rules regarding the manner in which it will make the enhanced payments, including the frequency with which the payments will be made.
(5) (a) A provider that receives an enhanced reimbursement rate under this section shall:
(i) provide to the department a summary of the diagnoses, behaviors, and ages for the medicaid-eligible children receiving services from the provider in fiscal year 2023; and
(ii) report annually to the department on the diagnoses, behaviors, and ages of the medicaid-eligible children receiving services from the provider during the fiscal year in which the provider receives an enhanced reimbursement rate.
(b) The department shall report the information required under subsection (5)(a) to the legislature in accordance with 5-11-210.
(6) For the purposes of this section, the term "high-risk child with multiagency service needs" has the meaning provided in 52-2-302. (Terminates June 30, 2027--sec. 4, Ch. 586, L. 2023.)
History: En. Sec. 1, Ch. 586, L. 2023.
2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 3. Montana State Hospital (Renumbered and Repealed) › 53-6-302. Repealed

53-6-302. Repealed.
Sec. 1, Ch. 80, L. 1987.
History: En. Sec. 18, Ch. 199, L. 1965; amd. Sec. 6, Ch. 320, L. 1967; R.C.M. 1947, 80-1702; amd. Sec. 1, Ch. 285, L. 1981; amd. Sec. 14, Ch. 361, L. 1983.
2023 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 › 53-6-401. Definitions

53-6-401. Definitions.
As used in this part, the following definitions apply:
(1) "Department" means the department of public health and human services provided for in 2-15-2201.
(2) "Home and community-based services" means, as provided for in section 1915 of Title XIX of the Social Security Act, 42 U.S.C. 1396n(c), and any regulations implementing that statute, long-term medical, habilitative, rehabilitative, and other services provided in personal residences or in community settings and funded by the department with medicaid money.
(3) "Level-of-care determination" means an assessment of a person and the resulting determination establishing whether long-term care facility services to be provided to the person are appropriate to meet the health care and related circumstances and needs of the person.
(4) "Long-term care facility" means a facility that is certified by the department, as provided in 53-6-106, to provide skilled or intermediate nursing care services, including intermediate nursing care services for persons with developmental disabilities or, for the purposes of implementation of medicaid-funded programs of home and community-based services, that is recognized by the U.S. department of health and human services to be an institutional setting from which persons may be diverted through the receipt of home and community-based services.
(5) "Long-term care preadmission screening" means, in accordance with section 1919 of Title XIX of the Social Security Act, 42 U.S.C. 1396r, a process conducted according to a specific set of criteria for determining whether a person with intellectual disability or mental illness may be admitted to a long-term care facility.
(6) "Persons with disabilities or persons who are elderly" means, for purposes of establishing home and community-based services, those categories of persons who are elderly and disabled as defined in accordance with section 1915 of Title XIX of the Social Security Act, 42 U.S.C. 1396n.
History: En. Sec. 1, Ch. 516, L. 1983; amd. Sec. 6, Ch. 711, L. 1989; amd. Sec. 21, Ch. 255, L. 1995; amd. Sec. 162, Ch. 418, L. 1995; amd. Sec. 458, Ch. 546, L. 1995; amd. Sec. 1, Ch. 72, L. 2005; amd. Sec. 2, Ch. 353, L. 2005; amd. Sec. 8, Ch. 68, L. 2013.
2023 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 › 53-6-403. Home and community-based services waivers -- legislative findings and intent

53-6-403. Home and community-based services waivers -- legislative findings and intent.
(1) The legislature finds that home and community-based services allow individuals who would otherwise need an institutional level of care to remain in their homes and to better integrate into their communities.
(2) The legislature further finds that home and community-based services offer a lower-cost alternative to institutional care.
(3) The legislature further finds that waiver participants often need multiple services that individually may not prevent institutionalization but when provided as a package allow a person to remain in a home or community setting.
(4) It is the intent of the legislature that in evaluating the services proposed for waiver participants, the department shall:
(a) review whether the services and equipment recommended by medical professionals will collectively, not individually, prevent an individual from requiring an institutional level of care; and
(b) approve each waiver service or item of medical equipment that will contribute to allowing a person to remain in a home or community setting even if the service or item on its own would not prevent an institutional level of care.
History: En. Sec. 1, Ch. 84, L. 2021.