reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.1 - Child Adoption Services › Rule 37.52.120 - ADOPTIVE PLACEMENT SERVICES PROVIDED

Current through Register Vol. 13, July 5, 2024
The department will:
(1) prepare a social study on children
				considered for adoption;
(2)
				counsel children considered for adoption;
(3) arrange for pre-placement visits with the
				family selected for placement;
(4)
				assist the family in formal adoption proceedings;
(5) supervise the adoptive placement;
				and
(6) counsel the family and
				child if the adoption is disrupted.
Sec.
					 53-4-111,
					 MCA; IMP, Sec.
					 53-4-112
					 and
					 53-4-115,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.1 - Child Adoption Services › Rule 37.52.125 - CHILD PLACEMENT, PROCEDURES FOR OBTAINING SERVICES

Current through Register Vol. 13, July 5, 2024
(1) A social worker may recommend adoptive
				placement for a child who is eligible for adoption and appears to be placeable
				by reason of age, adjustment and family situation.
(2) Another licensed agency or a court could
				recommend adoptive placement of a child. Referral may be in person, in writing
				or by telephone.
Sec.
					 53-4-111,
					 MCA; IMP, Sec.
					 53-4-112
					 and
					 53-4-115,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.2 - Subsidized Adoption › Rule 37.52.201 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of this subchapter is to
				encourage and promote the adoption of children who are hard-to-place by
				providing information and assistance in completing the adoption process and
				financial assistance when necessary to insure the health and welfare of the
				hard-to-place child.
Sec.
					 53-4-304,
					 MCA; IMP, Sec.
					 53-4-302,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.2 - Subsidized Adoption › Rule 37.52.204 - ELIGIBILITY REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) All criteria
				found in Title 40, chapter 8, part 1, MCA for adoption must be met.
(2) A child is certified as hard-to-place if
				he meets at least one of the following criteria:
(a) is handicapped because of physical,
				mental or emotional defects;
(b) is
				3 years of age or older; or
(c) is
				a sibling.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.2 - Subsidized Adoption › Rule 37.52.205 - APPLICATION OF PROSPECTIVE ADOPTIVE FAMILY

Current through Register Vol. 13, July 5, 2024
(1)
				A family may be considered for subsidized adoption if they meet all the
				standards for adoption but whose financial resources are temporarily or
				indefinitely inadequate to assume complete financial care of the
				child.
(2) A foster family may be
				appropriate if there is a meaningful relationship between the child and family
				and if the family has expressed an interest in a permanent relationship with
				the child but who need a subsidy to adopt the child. It would not be
				appropriate if the child has a relationship with the biological parents and
				continual contacts are being made.
Sec.
					 53-4-304,
					 MCA; IMP, Sec.
					 53-4-308,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.2 - Subsidized Adoption › Rule 37.52.206 - AMOUNT AND DETERMINATION OF SUBSIDY

Current through Register Vol. 13, July 5, 2024
(1)
				A department representative will evaluate the family's needs and the aid
				necessary to help the child and family. It will be based on the family
				situation, including income and expenses. The current federal income tax
				statement will be examined. The need for a subsidy must be based on the needs
				of the family that are attributable to the placement of the child. Subsidy may
				be made for a limited time or over a long term depending on whether the
				family's income is limited and the possibilities that it may remain limited.
				The monthly payment will continue until the child is 18 years of age.
(2) Medical costs do not include those which
				can be or are covered beyond completion of the adoption. It may continue until
				such time as the physician discharges a child from care of a medical
				problem.
(3) Special purpose
				assistance may be allowed in the event a child requires a special service, but
				such assistance may not exceed the cost of a similar service provided by the
				department for children who are legal wards of the department.
Sec.
					 53-4-304,
					 MCA; IMP, Sec.
					 53-4-310,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.2 - Subsidized Adoption › Rule 37.52.210 - REVIEW OF SUBSIDY PAYMENT

Current through Register Vol. 13, July 5, 2024
(1) A
				subsidized adoption agreement will be signed indicating the amount and duration
				of the subsidy. The subsidy established by this agreement may be modified upon
				request by the adoptive parents based upon changes in the needs of the child or
				upon a change in circumstances which affects the adoptive family. A change in
				the maximum allowable subsidy established by law is also an acceptable reason
				to seek a subsidy adjustment.
42-10-104,
					 MCA; IMP,
					 42-10-107,
					 42-10-108,
					 42-10-109,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.2 - Subsidized Adoption › Rule 37.52.214 - POST PLACEMENT

Current through Register Vol. 13, July 5, 2024
(1) Post-placement
				supervision will continue for 1 year. The adoptive family must notify the
				department of any changes in their financial situation, which may affect the
				subsidy. In addition, the family must submit medical expenses and need for
				continuation of the subsidy.
Sec.
					 53-4-304,
					 MCA; IMP, Sec.
					 53-4-311,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.52 - ADOPTIVE SERVICES › Subchapter 37.52.2 - Subsidized Adoption › Rule 37.52.220 - OTHER AGENCIES

Current through Register Vol. 13, July 5, 2024
(1) Other adoptive
				agencies may qualify for this program if the agency has permanent custody of a
				child and has exhausted all possible attempts for permanent adoptions including
				reference to the department. Application will be made with the field supervisor
				in the appropriate district.
Sec.
					 53-4-304,
					 MCA; IMP, Sec.
					 53-4-304,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.1 - General Requirements › Rule 37.55.101 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Claimant" means a person applying for
				assistance from the ESRD.
(2) "End
				stage renal disease" means severe kidney disease or kidney failure which is
				irreversible and permanent, and which requires dialysis or kidney
				transplantation to control uremia and maintain life.
(3) "EOB" means an explanation of benefit
				form.
(4) "ESRD" means the
				end-stage renal disease program administered by the department pursuant to
				chapter 692 of the 1983 session laws.
(5) "Family unit" means the individuals who
				are dependent upon a common primary source of financial support, including, but
				not limited to:
(a) the claimant,
(b) the claimant's spouse,
(c) the claimant's natural or adopted
				children under 18 years of age, and
(d) when the claimant is under 18 years of
				age, the claimant's natural or adoptive parents and the claimant's siblings
				living with them.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.2 - Benefits and Application › Rule 37.55.201 - APPLICATION PROCEDURES

Current through Register Vol. 13, July 5, 2024
(1) A new applicant
				must:
(a) submit an application to the
				department in writing on the form and in the manner prescribed by the
				department together with all income information and documentation supporting
				eligibility; and
(b) ensure that
				the application's witness and certification of economic need statements are
				signed prior to submission of the application.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.2 - Benefits and Application › Rule 37.55.202 - TIME PERIOD FOR BENEFITS

Current through Register Vol. 13, July 5, 2024
(1) An approved
				application entitles the claimant to ESRD benefits, to the extent the ESRD
				appropriation allows, for the following periods:
(a) for July 1 to June 30 of each fiscal
				year. Benefits shall begin in the month following receipt of and approval of
				the claimant's application. Retroactive benefits are not available;
(b) if a claimant's application is originally
				denied, or the claimant's circumstances change in such a way as to impact
				eligibility during any fiscal year, the claimant may submit a new application
				and the department will reconsider its eligibility determination.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.2 - Benefits and Application › Rule 37.55.206 - NOTICE OF END OF ESRD BENEFITS

Current through Register Vol. 13, July 5, 2024
(1) Whenever it
				appears that the ESRD appropriation for the fiscal year in question will be
				used up before the end of that fiscal year, the department will provide a news
				release to each major wire service serving Montana announcing the imminent
				cessation of benefits and individual notice of the cessation to each person
				approved for ESRD participation and to each renal dialysis center within
				Montana.
Sec.
					 50-44-102 and
					 53-6-202,
					 MCA; IMP, Sec.
					 50-44-102 and
					 53-6-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.3 - Eligibility › Rule 37.55.301 - NON-FINANCIAL ELIGIBILITY REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1)
				In order to participate in ESRD, the claimant applying for benefits must:
(a) have medical verification of end-stage
				renal disease from a licensed physician who is board eligible or certified in
				nephrology or a related specialty;
(b) be on dialysis or have received a kidney
				transplant;
(c) be a resident of
				the state of Montana; and
(d)
				participate in medicare part A and part B or have written documentation from
				the social security administration that the claimant is not eligible for social
				security benefits
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.3 - Eligibility › Rule 37.55.303 - FINANCIAL ELIGIBILITY REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1)
				In order to participate in ESRD, the claimant must take all reasonable steps
				necessary to apply for and exhaust any and all third party benefits, other than
				ESRD, to which the claimant is or may be entitled.
(2) If costs of treatment for end stage renal
				disease remain unpaid after the claimant has exhausted all other third party
				benefits, ESRD will pay the following benefits, provided funds are available:
(a) for claimants whose family unit's income
				is 200% of federal poverty level or less, ESRD will pay the claimant's unpaid
				costs for treatment of end stage renal disease or $1000 per month, whichever is
				less, except the ESRD will not pay medicaid copayments or medicaid deductibles
				for the claimant;
(b) for claimants
				whose family unit's income is between 200% and 300% of federal poverty level,
				ESRD will prorate the available benefits by determining the percentage of
				income over 200% of federal poverty level and applying that percentage to the
				benefit cap of $1000 per month except the ESRD will not pay medicaid copayments
				or medicaid deductibles for the claimant;
(c) for claimants whose family unit's income
				is over 300% of federal poverty level, no benefits are available from
				ESRD.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.5 - Services and Supplies › Rule 37.55.501 - ELIGIBLE SERVICES AND SUPPLIES: GENERAL

Current through Register Vol. 13, July 5, 2024
(1) The department, to the extent of its
				appropriation for ESRD, will pay for the costs listed in ARM
				37.55.502 for approved
				ESRD-eligible individuals only if each service or supply is directly related to
				end stage renal disease, medically necessary, ordered by a physician, and
				provided after the time the individual's application has been approved by the
				department.
Sec.
					 50-44-102 and
					 53-6-202,
					 MCA; IMP, Sec.
					 50-44-102 and
					 53-6-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.5 - Services and Supplies › Rule 37.55.502 - ELIGIBLE SERVICES AND SUPPLIES

Current through Register Vol. 13, July 5, 2024
(1) ESRD
				will pay for the cost of each of the following services and supplies which
				remains after all available third-party benefits have been utilized to pay for
				them:
(a) For home or center dialysis:
(i) insertion and maintenance of access
				site;
(ii) physician and hospital
				service for maintenance of home dialysis;
(iii) the following medications, not
				exceeding a 30-day supply:
(A) hepatitis
				vaccine;
(B) gamma
				globulin;
(C) whole
				blood;
(D) hyperphosphatemia
				(phosphate binder) drugs;
(E)
				hypocalcemia drugs;
(F) vitamins,
				iron, and/or folic acid;
(G)
				vitamin D preparations;
(H)
				hypertensive drugs;
(I)
				diuretics;
(J) antibiotics for
				peritonitis associated with peritoneal dialysis.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.5 - Services and Supplies › Rule 37.55.505 - NON-ELIGIBLE SERVICES

Current through Register Vol. 13, July 5, 2024
(1) The cost of the
				following services and supplies is not eligible for payment from ESRD:
(a) attendant or back-up person;
(b) drugs not specifically listed in ARM
				37.55.502 as eligible
				medications;
(c) transportation for
				anyone other than a cadaveric transplant patient;
(d) out-of-state dialysis care unless the
				care is directly related to a kidney transplant or a medical referral has been
				made by the patient's managing Montana nephrologist;
(e) any transportation for living related
				donor;
(f) services provided which
				are not related to kidney condition, e.g., epistaxis, otitis media, diabetes,
				eye examinations, and heart evaluations;
(g) medicare premiums;
(h) hospital in-patient care of over 60 days
				unless specifically justified as ESRD-related (e.g., not due to chronic
				debilitating disease other than renal disease) ;
(i) access-site surgery prior to initiation
				of dialysis treatments; and
(j)
				medicaid copayments or medicaid deductibles.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.7 - Claims Procedures and Payments › Rule 37.55.701 - DOCUMENTATION OF CLAIMS

Current through Register Vol. 13, July 5, 2024
(1) A claim for
				ESRD reimbursement, in order to be reimbursable, must contain, or be
				accompanied by, the documentation required by this rule.
(2) Each claim for any reimbursable service
				or supply must contain:
(a) the patient's
				name and address; and
(b) the
				provider's federal tax identification number.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.7 - Claims Procedures and Payments › Rule 37.55.702 - CONDITIONS OF CLAIM PAYMENT

Current through Register Vol. 13, July 5, 2024
(1) Payment of
				a claim will be made only when the amount payable by ESRD exceeds
				$20.
(2) Payment will be made,
				subject to (5) below, directly to the provider for that portion of the cost of
				eligible services or supplies which does not exceed either the amount allowed
				by medicare for the particular service or supply or the actual costs, whichever
				is less.
(3) Payment will be made
				only after all other reasonably available sources of payment, such as medicare
				or private insurance, have either paid in part or denied payment for the
				services or supplies.
(4) Payments
				for drugs will be made, subject to (5) below, only to the extent that the
				charges do not exceed the average wholesale price specified in the drug topics
				redbook for the specific drug. The department hereby adopts and incorporates by
				reference the most current version of the "Annual Pharmacists' Reference",
				referred to as the drug topics redbook which contains the average wholesale
				prices for most commercially available drugs. A copy of the drug topics redbook
				may be obtained from Drug Oradell, New York 07649. The average wholesale price
				for drugs used to treat end stage renal disease may be obtained from the
				Department of Public Health and Human Services, Health Policy and Services
				Division, ESRD Program, 1400 Broadway, P.O. Box 202951, Helena, MT
				59620-2951.
(5) Benefit payments
				may not exceed $1000 per month per eligible claimant.
Sec.
					 50-44-102 and
					 53-6-202,
					 MCA; IMP, Sec.
					 50-44-102 and
					 53-6-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.7 - Claims Procedures and Payments › Rule 37.55.705 - PRIORITY OF PAYMENT

Current through Register Vol. 13, July 5, 2024
(1) To the extent
				of the ESRD appropriation for a given fiscal year, bills received by the
				department during that fiscal year will be paid according to the date ESRD
				receives them, the first bills received being the first paid.
Sec.
					 50-44-102 and
					 53-6-202,
					 MCA; IMP, Sec.
					 50-44-102 and
					 53-6-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.55 - END STAGE RENAL DISEASE (ESRD) › Subchapter 37.55.10 - Hearing and Appeal Procedures › Rule 37.55.1001 - RIGHT TO RECONSIDERATION OF ADVERSE END STAGE RENAL DISEASE PROGRAM DECISION

Current through Register Vol. 13, July 5, 2024
(1) Any claimant
				who is aggrieved by an adverse department end stage renal disease (ESRD) action
				on an application may, upon request, have an informal reconsideration in
				accordance with the procedures prescribed for informal reconsiderations in ARM
				37.5.311. The informal
				reconsideration is not subject to the contested case provisions of the Montana
				Administrative Procedure Act, Title 2, chapter 4, MCA or, except as provided in
				this rule, the provisions of
				37.5.304,
				37.5.305,
				37.5.307,
				37.5.310, 37.5.311, 37.5.313,
				37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and
				37.5.337.
Sec.
					 50-44-102 and
					 53-6-202,
					 MCA; IMP, Sec.
					 50-44-102 and
					 53-6-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.101 - PURPOSE OF RULES

Current through Register Vol. 13, July 5, 2024
(1) The purpose of
				the children's special health services program rules is to provide treatment
				and enabling services for children and youth with special health care
				needs.
AUTH:
					 50-1-202,
					 MCA; IMP:
					 50-1-202,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.105 - GENERAL REQUIREMENTS FOR CSHS FINANCIAL ASSISTANCE

Current through Register Vol. 13, July 5, 2024
(1) In order to receive CSHS financial
				assistance for a particular benefit a CYSHCN must meet the eligibility
				requirements of ARM
				37.57.106.
AUTH:
					 50-1-202,
					 MCA; IMP:
					 50-1-202,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.106 - ELIGIBILITY FOR CSHS FINANCIAL ASSISTANCE

Current through Register Vol. 13, July 5, 2024
(1)
				Eligibility criteria for CSHS financial assistance are:
(a) an individual under the age of 22 who
				meets the definition of a child or youth with special health care needs
				(CYSHCN);
(b) a resident of the
				state of Montana and either a U.S. citizen or a qualified alien as defined
				under federal statute; and
(c) in
				need of a treatment or enabling services related to their disabling condition
				or risk category, which is recommended by a medical professional, where an
				out-of-pocket expense would be the responsibility of the family and no other
				means of payment is available to cover the out-of-pocket expenses.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.109 - APPLICATION PROCEDURE FOR CSHS FINANCIAL ASSISTANCE

Current through Register Vol. 13, July 5, 2024
(1) A person who desires CSHS financial
				assistance for a CYSHCN must submit a completed CSHS financial assistance
				application, along with required supporting documents. This application is
				available by contacting CSHS at 1-800-762-9891 or visiting
www.cshs.mt.gov
.
(2) If the department notifies the applicant
				that the application is incomplete, the requested missing information must be
				received by CSHS within six weeks from the date of notification; otherwise the
				application will be considered inactive. If the requested information is
				subsequently received and the CYSHCN is found to be eligible, the eligibility
				year will begin on the date the additional requested information is received.
(3) If the CYSHCN is determined
				ineligible, the department will send the applicant a written notice stating the
				reasons for ineligibility and explaining how an informal reconsideration of its
				determination may be obtained pursuant to ARM
				37.57.112.
(4) When the CYSHCN is determined eligible,
				the department will send the applicant a written notice specifying which
				services are eligible for CSHS financial assistance and the term of
				eligibility.
AUTH:
					 50-1-202,
					 MCA; IMP:
					 50-1-202,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.110 - CONDITIONS AND SERVICES FOR CSHS FINANCIAL ASSISTANCE (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 50-1-202,
					 MCA; IMP:
					 50-1-202,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.111 - PAYMENT LIMITS AND REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) The
				department will provide financial assistance for a CSHS-eligible CYSHCN with a
				covered condition:
(a) if the benefit is not
				covered by another payment source, with the exception of the Indian health
				service (IHS), which is a payer of last resort;
(b) if the department has sufficient federal
				funds to provide the benefit;
(c)
				up to a maximum of $2,000 per eligibility year;
(d) for a CYSHCN under age three, CSHS will
				pay after the early intervention program, part C, of the disabilities services
				division; and
(e) after all third
				parties, if any, have paid the provider, in which case the department pays any
				balance remaining for services to the lower of the health care coverage allowed
				amount or the CSHS allowed amount for the services in question.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.112 - INFORMAL RECONSIDERATION PROCEDURE

Current through Register Vol. 13, July 5, 2024
(1)
				A CYSHCN who has been denied eligibility for CSHS, a provider who has been
				denied reimbursement for services or covered benefits, or anyone who is
				otherwise adversely affected by denial for CSHS financial assistance may have
				informal reconsideration. The party requesting such a reconsideration must do
				so within 60 days after notice of the adverse action in question has been
				placed in the mail or otherwise communicated to the aggrieved party.
(2) A request for a reconsideration, in order
				to be considered, must be in writing, include refutation of the department's
				findings, and be postmarked no later than the 60th day after notice of the
				adverse action referred to in (1) was given.
(3) If the department receives a request for
				an informal reconsideration, it will conduct the reconsideration within 30 days
				after the date the request is received unless both the requestor and the
				department agree to a later date.
(4) An informal reconsideration will be
				conducted in accordance with the procedures prescribed for informal
				reconsideration in ARM
				37.5.311,
				with the exceptions noted in (1) and (5). Such informal reconsideration is not
				subject to the provisions of the Montana Administrative Procedure Act, Title 2,
				chapter 4, MCA, or, except as provided in this rule, the provisions of ARM
				37.5.304,
				37.5.307,
				37.5.310,
				37.5.313,
				37.5.316,
				37.5.318,
				37.5.322,
				37.5.325,
				37.5.328,
				37.5.331,
				37.5.334 and
				37.5.337.
(5) In addition to the procedures specified
				in ARM 37.5.311, an applicant shall be provided an opportunity to appear and
				present evidence and arguments in person.
(6) The decision by the department after an
				informal reconsideration is final.
AUTH:
					 50-1-202,
					 MCA; IMP:
					 50-1-202,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.117 - CSHS PROVIDERS RECEIVING CSHS FUNDS: REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) In order to be a CSHS provider for a CSHS
				client, a provider must meet the following requirements:
(a) A physician or surgeon must:
(i) be currently licensed by the state of
				Montana pursuant to Title 37, chapter 3, MCA, or currently licensed to practice
				medicine in the state in which they reside;
(ii) provide the department, upon request,
				with adequate documentation of credentials needed to prove program
				eligibility.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.118 - PROGRAM RECORDS

Current through Register Vol. 13, July 5, 2024
(1) The department
				will retain specialty clinic participants case files of CSHS services provided
				for a client for a period of five years after the child reaches the age of 18
				as set forth in the Montana Secretary of State records retention schedule,
				records series title "Specialty Clinic Participant Case Files."
(2) Prior to destroying specialty clinic
				participant case files, the department will advertise that the case files may
				be obtained by those to whom they pertain by publishing a notice in Montana's
				major newspapers once per week for three consecutive weeks.
(3) Case files remaining unclaimed for three
				months after the public notice described in (2) is completed will be destroyed
				after the department receives the approval of the state records committee
				required by
				2-6-212, MCA.
(4) The department will retain CSHS financial
				assistance case files for five years from the last service date, as set forth
				in the Montana Secretary of State records retention schedule, records series
				title "Financial Assistance Case Files."
(5) The financial assistance case files will
				be destroyed after the program receives approval from the state records
				committee required under
				2-6-212, MCA.
(6) The department will retain CSHS clinic
				billing files for five calendar years as set forth in the Montana Secretary of
				State records retention schedule, record series title "Clinic Billing
				Reimbursement Records."
(7) Clinic
				billing files will be destroyed after the program receives approval from the
				state records committee required under
				2-6-212, MCA.
(8) The department will retain all electronic
				data as set forth in the Montana Secretary of State records retention schedule,
				records series title "CHRIS Files."
50-1-202,
					 MCA; IMP,
					 50-1-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.1 - Handicapped Children's Services Program › Rule 37.57.125 - ADVISORY COMMITTEE (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 50-1-202,
					 MCA; IMP, Sec.
					 50-1-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.301 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
As used in this subchapter, the following definitions apply:
(1) "Health care facility" means a
				hospital or other facility licensed by or located in the state of Montana for
				the purpose of providing health care services, and which provides primary
				health care services for newborns at birth.
(2) "Newborn" means an infant in the first 28
				days of life.
(3) "Newborn
				screening tests" are screening tests, procedures, or both for the following
				conditions:
(a) Acylcarnitine Disorders:
(i) Fatty Acid Oxidation Disorders:
(A) Carnitine uptake defect;
(B) Long-chain L-3-OH acyl-CoA dehydrogenase
				deficiency;
(C) Medium-chain
				acyl-CoA dehydrogenase deficiency;
(D) Trifunctional protein deficiency; and
(E) Very long-chain acyl-CoA
				dehydrogenase deficiency;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.304 - NEWBORNS HOSPITALIZED FOR NEONATAL INTENSIVE CARE

Current through Register Vol. 13, July 5, 2024
(1) If a newborn is hospitalized for neonatal
				intensive care, a specimen of its blood must be taken for testing prior to
				nonrespiratory treatment and no later than 48 hours of age, unless medically
				contraindicated, in which case the specimen must be taken as soon as the
				infant's medical condition permits.
(2) In the event that the initial screening
				blood specimen is taken at less than 24 hours of age, another screening
				specimen must be taken after 48 hours of age, and no later than 7 days of
				age.
(3) In the event that the
				newborn stays in a health care facility past 7 days of age, an additional
				screening blood specimen must be taken either at the time of discharge if the
				stay is less than one month, or at one month of age if the stay is one month or
				longer.
(4) Hospitals providing
				neonatal intensive care are responsible for developing and implementing a
				protocol to ensure a newborn hospitalized for neonatal intensive care receives
				screening for critical congenital heart disease.
50-19-202, MCA;
					 IMP,
					 50-19-203,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.305 - NEWBORNS OTHER THAN THOSE HOSPITALIZED FOR NEONATAL INTENSIVE CARE

Current through Register Vol. 13, July 5, 2024
(1) For newborns not requiring neonatal
				intensive care, the required blood specimen must be taken between 24 and 48
				hours of age.
(2) In the event the
				newborn is discharged from a health care facility prior to 24 hours of age, the
				blood specimen must be taken immediately before discharge and, in addition:
(a) another specimen must be taken and
				submitted to the department's laboratory between the second and seventh day of
				the newborn's life; and
(b) the
				health care facility must:
(i) explain the
				reasons why it is of utmost importance to return for these tests; and
(ii) ensure that the parent or legal guardian
				of the newborn signs a statement assuming responsibility to cause a specimen to
				again be taken between the second and seventh day of life of the newborn and to
				submit it to the department for testing.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.306 - TRANSFER OF NEWBORN INFANT

Current through Register Vol. 13, July 5, 2024
(1) In the
				event of transfer of a newborn from one health care facility to another, or
				from a place of birth that is not a health care facility to a health care
				facility, a screening blood specimen must be taken and submitted by the
				receiving health care facility.
(2)
				A receiving health care facility must take specimens as necessary for follow-up
				tests as required by this subchapter.
(3) In the event of a transfer of a newborn
				from one health care facility to another, or from a place of birth that is not
				a health care facility to a health care facility, pulse oximetry screening for
				CCHD must be completed after 24 hours of age by the receiving health care
				facility and screening results reported to the department as required by this
				subchapter.
50-19-202, MCA;
					 IMP,
					 50-19-203,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.307 - INFANT BORN OUTSIDE HEALTH CARE FACILITY

Current through Register Vol. 13, July 5, 2024
(1)
				When an infant is born outside of a health care facility and is not
				subsequently transferred to a health care facility for initial newborn care, it
				is the responsibility of one of the persons designated in
				50-15-221(4)(a),
				(b), and (c), MCA, in the order of priority
				indicated therein, to cause the blood specimen to be taken and submitted, and
				to cause pulse oximetry screening to be performed as required by this
				subchapter.
50-19-202, MCA;
					 IMP,
					 50-19-203,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.308 - NEWBORN EYE TREATMENT

Current through Register Vol. 13, July 5, 2024
(1) A physician,
				nurse-midwife, or any other person who assists at the birth of any newborn
				must, within the time limit stated in (3), instill or have instilled into each
				conjunctival sac of the newborn, erythromycin (0.5%) ophthalmic ointment or
				drops from single-use tubes or ampules.
(2) A prophylactic agent referred to in (1)
				above may not be flushed from a newborn's eyes after instillation.
(3) The prophylactic agent must be
				administered to a newborn within one hour after its birth unless it is
				physically impossible to obtain the agent within that time, in which case the
				agent must be administered as soon as possible.
50-1-202,
					 MCA; IMP,
					 50-1-202,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.315 - TRANSFUSION: WHEN BLOOD SPECIMEN TAKEN

Current through Register Vol. 13, July 5, 2024
(1)
				If a newborn needs a transfusion, blood specimens for the tests required by
				this subchapter must be taken before the transfusion takes place unless
				medically contraindicated.
(2) If
				the newborn is transfused prior to collection of the initial newborn screening
				specimen, a screening specimen must be taken 90 to 120 days after the last
				transfusion to screen for classical galactosemia and hemoglobinopathies. This
				specimen is in addition to those required elsewhere in this chapter.
50-19-202, MCA;
					 IMP,
					 50-19-203,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.316 - REPORTING SCREENING RESULTS

Current through Register Vol. 13, July 5, 2024
(1) If
				screening results on an infant's blood specimen are within the expected or
				normal range the department will report the results to the submitter of the
				specimen and, in addition, to the infant's healthcare provider(s) upon
				request.
(2) If the infant's blood
				specimen is of unsatisfactory quality for testing, the department will notify
				the submitter of the need for collection of an additional specimen. The
				submitter must ensure collection of this specimen in a timely manner within
				three days of notification.
(3) If
				screening results on an infant's blood specimen are outside the expected or
				normal range:
(a) the department will report
				results to the submitter of the specimen and to the healthcare provider(s) for
				the infant. Recommendations for follow-up actions contained in the report are
				determined by the department;
(b)
				the provider(s) will ensure that all repeat screening, confirmatory testing, or
				both, as recommended, is collected and submitted to the department or an
				approved laboratory within 48 hours or as clinically appropriate;
(c) if a referral to a contracted specialist
				is made by the department, the specialist will ensure that all confirmatory
				testing results and final diagnosis are reported to the department within one
				week of the determination of the final diagnosis.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.320 - RESPONSIBILITIES OF REGISTRAR OF BIRTH: ADMINISTRATOR OF HEALTH CARE FACILITY

Current through Register Vol. 13, July 5, 2024
(1) Each person in charge of any health care
				facility and each person responsible under ARM
				37.57.307 for a birth occurring
				outside a health care facility must:
(a)
				ensure that a blood specimen is taken from each newborn for which the health
				care facility or person is responsible, in conformity with this subchapter, for
				the purpose of performing newborn screening tests;
(b) be certain that the specimen to be
				forwarded to the laboratory is adequate for testing purposes;
(c) within 24 hours after the taking of the
				specimen, cause such specimen to be forwarded to the department's laboratory by
				either courier or first-class mail or its equivalent;
(d) record in the newborn's medical record
				the date of taking of the test specimen and the results of the tests performed
				when reported by the department;
(e) ensure that pulse oximetry is performed
				per the department's recommended protocol for the purpose of performing newborn
				screening for CCHD as follows:
(i) ensure
				that the screening is performed on equipment that has been approved by the FDA
				for use on newborns and is motion tolerant;
(ii) ensure that screening is performed by
				licensed staff who have been trained on the screening procedure and
				protocol;
(iii) record in the
				newborn's medical record the date, time, and screening results;
(iv) ensure that the pulse oximetry screening
				results are reported to DPHHS as required by this subchapter;
(v) ensure that a policy and procedure is in
				place for immediate follow-up of a failed CCHD screen; and
(f) use educational materials provided by the
				department and must provide education to the newborn's family on the following:
(i) the conditions that may be detected
				through bloodspot screening and pulse oximetry screening;
(ii) the importance of newborn screening
				tests to detect potentially life- threatening conditions;
(iii) the process for collecting bloodspot
				screening and conducting pulse oximetry screening; and
(iv) after hearing all the benefits of
				newborn screening and the risks involved in refusing testing, a parent/legal
				guardian may refuse either of the above screenings. In that case, the
				parent/legal guardian must sign a waiver for the newborn's medical record in
				which they accept responsibility for adverse consequences. A copy of this
				waiver must be provided to the department.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.3 - Infant Screening Tests and Eye Treatment › Rule 37.57.321 - STATE LABORATORY

Current through Register Vol. 13, July 5, 2024
(1) Only those
				newborn screening blood tests performed by the department laboratory or a
				laboratory approved by the department meet the requirements of
				50-19-201,
				50-19-202,
				50-19-203,
				and
				50-19-204,
				MCA.
(2) Dried blood specimens
				remaining after newborn screening test completion are the property of the
				department laboratory and will be stored for one calendar year prior to
				destruction. Any dried blood specimens sent to a laboratory approved by the
				department for testing will be destroyed after one year by the approved
				laboratory. An exception is made for screening specimens with results that are
				out of range which may be kept for quality improvement and new method
				development within the laboratory. These specimens may be stored by the
				laboratory for an indefinite period of time.
50-19-202, MCA;
					 IMP,
					 50-19-203,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.4 - Newborn Hearing Screening and Assessment › Rule 37.57.401 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Health care provider" means a person
				licensed in the state of Montana to provide health care services to pregnant
				women and/or newborn infants and who is the primary health care provider in
				attendance at the birth of a newborn infant born outside of a hospital or
				health care facility. The term includes direct-entry midwives.
(2) "Hospital or health care facility that
				provides obstetric services" means any hospital or health care facility
				licensed by or operating in the state of Montana that routinely provides or
				holds itself out as providing obstetric services, without regard for the number
				of births actually occurring in that hospital or health care facility on an
				annual basis.
(3) "Newborn" means
				any infant from birth through 28 days of age.
53-19-402,
					 MCA; IMP,
					 53-19-402,
					 53-19-404,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.4 - Newborn Hearing Screening and Assessment › Rule 37.57.403 - NEWBORN HEARING SCREENING EDUCATION

Current through Register Vol. 13, July 5, 2024
(1) Each
				licensed hospital and health care facility shall provide education to the
				parents of any newborn born in the hospital or health care facility or
				transferred to the hospital or health care facility from the newborn's place of
				birth, unless the newborn has previously been provided a hearing screening test
				by a hospital or health care facility from which the newborn was transferred,
				on:
(a) hearing loss;
(b) the importance of early hearing
				screening; and
(c) the process for
				conducting newborn hearing screening.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.4 - Newborn Hearing Screening and Assessment › Rule 37.57.406 - NEWBORN HEARING SCREENING - REFERRALS FOR NEWBORNS BORN OUTSIDE OF HOSPITALS OR HEALTH CARE FACILITIES

Current through Register Vol. 13, July 5, 2024
(1) Each health
				care provider who is required to provide newborn hearing screening education
				shall also provide referral information to the parents of any newborn who was
				born outside of a hospital or health care facility. The referral information
				shall identify the hospitals, health care facilities, and other health care
				providers in the region that are able to provide hearing screenings for
				newborns.
53-19-402,
					 MCA; IMP,
					 53-19-404,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.57 - MATERNAL AND CHILD HEALTH › Subchapter 37.57.4 - Newborn Hearing Screening and Assessment › Rule 37.57.407 - NEWBORN HEARING SCREENING PROTOCOLS - HOSPITALS AND HEALTH CARE FACILITIES

Current through Register Vol. 13, July 5, 2024
(1) Each licensed hospital or health care
				facility that provides obstetric services shall establish a newborn hearing
				screening program in order to ensure that a hearing screening is provided for
				each newborn born in the hospital or health care facility or transferred to the
				hospital or health care facility from the newborn's place of birth, unless the
				newborn was previously provided a hearing test by a hospital or health care
				facility from which the newborn was transferred.
(a) An initial hearing screening must be
				performed prior to the infant's discharge from the hospital or health care
				facility.
(b) If the results of the
				initial hearing screening were inconclusive or indicated a possible hearing
				loss, a second screening must be performed prior to the newborn's discharge
				from the hospital or health care facility, if possible. If a second hearing
				screening cannot be performed prior to the infant's discharge from the
				hospital, the hospital or health care facility must, prior to the discharge,
				work with the newborn's parents to schedule a second hearing screening for the
				newborn. The second screening shall be scheduled at the hospital or health care
				facility from which the newborn is being discharged. It shall be scheduled to
				occur within 30 days of the newborn's birth.