reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3015 - OUTPATIENT HOSPITAL REIMBURSEMENT, OUTPATIENT HOSPITAL REIMBURSEMENT ADJUSTOR

Current through Register Vol. 13, July 5, 2024
(1) The outpatient
				hospital reimbursement adjustor (HRA) payment is payable to a PPS hospital or
				critical access hospital, as those terms are defined in
				50-5-101,
				MCA, that provides outpatient hospital services. Eligibility to receive the
				outpatient HRA is based on a hospital's year-end reimbursement
				status.
(2) An individual
				hospital's outpatient HRA payment will be based upon total hospital Medicaid
				outpatient charges and will be computed as follows: HRA = (J ÷ D) x P.
(a) "HRA" represents the calculated hospital
				specific outpatient HRA payment.
(b) "J" equals the total outpatient hospital
				charges billed to Medicaid by the hospital for which the payment is
				calculated.
(c) "D" equals the
				total outpatient hospital charges billed to Medicaid by all hospitals eligible
				to receive an outpatient HRA payment.
(d) "P" equals the distributable revenue
				generated by the outpatient hospital utilization fee plus applicable federal
				financial participation.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3016 - OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, IMAGING SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Imaging
				services will be reimbursed with the exception of hospitals reimbursed under
				ARM 37.86.3005(3) as
				follows:
(a) For each imaging service or
				procedure, the fee will be the APC rate as in ARM
				37.86.3020 or Medicare fee if no
				APC rate exists. The imaging services reimbursed under this subsection are the
				individual imaging service codes defined in the CPT/HCPCS.
(b) For imaging services where no APC rate or
				Medicare fee has been assigned, a Medicaid fee will be set in accordance with
				the resource based relative value scale (RBRVS) methodology found at ARM
				37.85.212.
(c) For imaging services where no APC rate,
				Medicare fee, or Medicaid fee has been assigned, outpatient hospital-specific
				percent of charges will be paid. Birthing centers and out-of-state hospitals
				will be reimbursed the statewide outpatient cost-to-charge ratio.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3018 - OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, OTHER DIAGNOSTIC SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Other
				diagnostic services will be reimbursed as follows with the exception of
				hospitals reimbursed under ARM
				37.86.3005(4):
(a) the fee will be the APC rate as in ARM
				37.86.3020 or the Medicare fee for
				the same service if no APC rate exists. The individual diagnostic services
				reimbursed under this subsection are those defined in the CPT/HCPCS;
(b) for other diagnostic services without an
				APC rate or Medicare fee, a Medicaid fee will be assigned in accordance with
				the RBRVS methodology in ARM
				37.85.212; or
(c) for other diagnostic services where no
				APC rate, Medicare fee, or Medicaid fee has been assigned, outpatient
				hospital-specific percent of charges will be paid. Birthing centers and
				out-of-state hospitals will be reimbursed the statewide outpatient
				cost-to-charge ratio.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3022 - OUTPATIENT HOSPITAL SERVICES, PARTIAL HOSPITALIZATION SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Partial hospitalization services will be
				reimbursed on a prospective per diem rate which shall be the lesser of the
				amount specified in the department's Medicaid Mental Health Fee Schedule or the
				provider's usual and customary charges (billed charges). The per diem rates
				specified in the department's Medicaid Mental Health Fee Schedule are bundled
				prospective per diem rates for full-day programs and half-day programs, as
				defined in ARM
				37.86.3001. The bundled
				prospective per diem rate includes all outpatient psychiatric and psychological
				treatments and services, laboratory and imaging services, drugs, biologicals,
				supplies, equipment, therapies, nurses, social workers, psychologists, licensed
				professional counselors, and other outpatient services, that are part of or
				incident to the partial hospitalization program, except as provided in the
				department's Medicaid Mental Health Fee Schedule.
(2) The professional component of physician
				services, including psychiatrist services, is separately billable according to
				the applicable department rules governing billing for physician
				services.
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-2-201,
					 53-6-101,
					 53-6-111,
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3025 - OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT FOR SERVICES NOT PAID UNDER THE AMBULATORY PAYMENT CLASSIFICATION SYSTEM

Current through Register Vol. 13, July 5, 2024
(1) Therapy services will be paid the
				facility fee in accordance with the RBRVS methodologies in ARM
				37.85.212
				using the allied services conversion factor. Therapy services include physical
				therapy, occupational therapy, and speech-language pathology and are subject to
				requirements and restrictions as in ARM
				37.86.606.
(2) Dental services not grouping
				to an ambulatory payment classification (APC) will be reimbursed as specified
				in the department's outpatient fee schedule.
(3) Immunizations not grouping to an APC will
				be paid the same reimbursement provided in accordance with the RBRVS
				methodologies in ARM 37.85.212.
(a) If the
				recipient is under 19 years old and vaccine is available to providers for free
				under the Vaccines For Children program, then the payment to the hospital is
				zero.
(b) Immunization
				administration is considered an incidental service and will be bundled with
				other APCs on the claim and paid at zero.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3031 - PROVIDER BASED ENTITY SERVICES, GENERAL (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3033 - PROVIDER-BASED ENTITY SERVICES, RECIPIENT ACCESS AND NOTIFICATION (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3035 - PROVIDER BASED ENTITY SERVICES, COMPLIANCE, AND PENALTIES (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-101,
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.30 - Outpatient Hospital Services › Rule 37.86.3037 - PROVIDER-BASED ENTITY SERVICES, REIMBURSEMENT (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-101,
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.31 - Outpatient Hospital Rehabilitation and Therapy Services › Rule 37.86.3101 - OUTPATIENT HOSPITAL SERVICES, CARDIAC AND PULMONARY REHABILITATION SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Coverage for
				medically necessary outpatient cardiac and pulmonary rehabilitation services is
				effective January 1, 2006.
(2) All
				cardiac and pulmonary rehabilitative services must be medically necessary and
				prior authorized by the department's designated review organization.
(3) The following conditions are
				contraindications to cardiac or pulmonary rehabilitation, and except as
				provided in ARM
				37.86.3107, patients with one or
				more contraindications are not eligible for cardiac or pulmonary
				rehabilitation:
(a) severe psychiatric
				disturbance including, but not limited to, dementia and organic brain syndrome;
				or
(b) significant or unstable
				medical conditions including, but not limited to, substance abuse, liver
				dysfunction, kidney dysfunction, and metastatic cancer.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.31 - Outpatient Hospital Rehabilitation and Therapy Services › Rule 37.86.3103 - OUTPATIENT HOSPITAL SERVICES, CARDIAC REHABILITATION SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Cardiac
				rehabilitation services are limited to the following cardiac events and
				diagnoses:
(a) myocardial infarction within
				the preceding 12 months;
(b)
				coronary artery bypass surgery;
(c)
				heart-lung transplant;
(d) current
				stable angina pectoris;
(e)
				percutaneous transluminal coronary angioplasty (PTCA) or coronary
				stenting;
(f) heart valve repair or
				replacement; and
(g) chronic stable
				heart failure.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.31 - Outpatient Hospital Rehabilitation and Therapy Services › Rule 37.86.3105 - OUTPATIENT HOSPITAL SERVICES, PULMONARY REHABILITATION SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Pulmonary
				rehabilitation services are limited to members with moderate to severe COPD,
				defined as GOLD classification II, III, and IV
(2) If applicable, the patient must have
				ceased smoking or be in a smoking cessation class.
(3) The following pulmonary rehabilitation
				services are not covered:
(a) education,
				treatment, and therapies that are not individualized to a specific patient need
				or are not an integral part of the treatment session;
(b) routine psychological screening and
				treatment where intervention is not indicated;
(c) films/videos;
(d) duplicate services;
(e) maintenance care when there is no
				expectation of further improvement;
(f) treatment that is not medically necessary
				because the patient requires a general strengthening and endurance program
				only; and
(g) treatment that is not
				medically necessary because the patient is at an early stage of pulmonary
				disease as demonstrated by a lack of significant findings in diagnostic
				testing.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.31 - Outpatient Hospital Rehabilitation and Therapy Services › Rule 37.86.3107 - OUTPATIENT HOSPITAL SERVICES, CARDIAC AND PULMONARY REHABILITATION, WAIVER OF SERVICE LIMITATIONS

Current through Register Vol. 13, July 5, 2024
(1) The service
				limitations provided in ARM
				37.86.3103 and
				37.86.3105 may be waived for
				extenuating circumstances on a case-by-case basis by the department.
53-2-201,
					 53-6-111,
					 MCA; IMP,
					 53-2-201,
					 53-6-101,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.31 - Outpatient Hospital Rehabilitation and Therapy Services › Rule 37.86.3109 - OUTPATIENT CARDIAC AND PULMONARY REHABILITATION REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Critical access hospital (CAH) interim
				reimbursement is based on a hospital-specific Medicaid outpatient
				cost-to-charge ratio, not to exceed 100%. For dates of service January 1, 2018
				through June 30, 2018, the interim reimbursement is based on the hospital
				specific Medicaid outpatient cost-to-charge ratio (CCR), less 2.99% not to
				exceed 100%. For dates of service on or after July 1, 2018, the interim
				reimbursement is based on the hospital-specific Medicaid outpatient
				cost-to-charge ratio. CAHs will be reimbursed their actual allowable costs
				determined according to ARM
				37.86.2803.
(2) Prospective payment hospitals will be
				reimbursed on a rate-per-service basis using the outpatient prospective payment
				system (OPPS) schedules as provided in ARM
				37.86.3020.
(3) Out-of-state hospitals will not be
				reimbursed for these services.
AUTH:
					 53-2-201,
					 53-6-111,
					 MCA; IMP:
					 53-2-201,
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.32 - Nonhospital Laboratory and Radiology (X-Ray) Services › Rule 37.86.3201 - NONHOSPITAL LABORATORY AND RADIOLOGY (X-RAY) SERVICES, REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) "Nonhospital laboratory and radiology
				(x-ray) services" are professional and technical laboratory and radiology
				services which are ordered and provided by a physician, dentist, or other
				practitioner licensed within the scope of his practice as defined by state
				law.
(2) Nonhospital laboratory and
				radiology (x-ray) services may be provided in an office or similar facility
				other than a hospital outpatient department or clinic.
(3) Providers must meet the following
				requirements:
(a) Providers of laboratory
				services must be:
(i) Medicare certified;
				and
(ii) meet licensing
				requirements of the state in which they are located.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.32 - Nonhospital Laboratory and Radiology (X-Ray) Services › Rule 37.86.3205 - NONHOSPITAL LABORATORY AND RADIOLOGY (X-RAY) SERVICES, REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) These reimbursement requirements are in
				addition to those contained in ARM
				37.85.212
				and
				37.86.105.
(2) Independent laboratory
				providers must meet the following requirements to receive Medicaid
				reimbursement:
(a) the independent laboratory
				provider must be certified by Medicare;
(b) the independent laboratory provider must
				meet any state licensing requirements for laboratory facilities; and
(c) the independent laboratory service must
				have been ordered by a physician, dentist, or other practitioner licensed to
				practice in Montana.
(i) Medicaid does not
				reimburse services ordered by chiropractors.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.33 - Case Management Services - General › Rule 37.86.3301 - CASE MANAGEMENT SERVICES, GENERAL DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Case management" means the process of
				planning and coordinating care and services to meet individual needs of a
				client and to assist the client in obtaining necessary medical, social,
				nutritional, educational, and other services. Case management includes
				assessment, case plan development, monitoring, and service coordination. Case
				management provides coordination among agencies and providers in the planning
				and delivery of services.
(2)
				"Caregiver" means a parent, family member, foster parent, or guardian with
				legal responsibility for the well-being of the client.
(3) "Case management provider" or "provider"
				means an entity that as provided for in this subchapter may provide case
				management services to clients.
(4)
				"Case manager" means a person or a team of persons assigned by a case
				management provider to do case management for the client.
(5) "Client" means a person who is eligible
				for and is receiving case management services.
(6) "Presumptive eligibility" means the
				process of determining eligibility for pregnant women to receive ambulatory
				prenatal care services under the Medicaid presumptive eligibility program as
				provided at ARM
				37.82.701.
(7) "Department" or "DPHHS" means the
				Department of Public Health and Human Services.
Sec.
					 53-6-113,
					 MCA; IMP, Sec.
					 53-6-101,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.33 - Case Management Services - General › Rule 37.86.3305 - CASE MANAGEMENT SERVICES, GENERAL PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1) Case management services assure healthy
				outcomes by assisting recipients to access needed services and by coordinating
				between all agencies and providers responsible for service delivery. A case
				management plan sets goals for meeting a client's needs and where appropriate
				the needs of the client's caregivers and identifies the means for implementing
				those goals with emphasis on the self-sufficiency of the client and caregivers
				in obtaining services.
(2) Case
				management services are available to persons who are determined by the
				department or its designees in accordance with this subchapter to be within the
				covered groups set forth in ARM
				37.86.3306.
(3) Receipt of case management services does
				not restrict a client's right to receive other Montana Medicaid services from
				any certified Medicaid provider.
(4) Case management services cannot duplicate
				any other Medicaid service or other services available to the client.
(5) Case management services must be
				delivered by a case manager whose primary responsibility is the delivery of
				case management services to one or more of the populations identified in ARM
				37.86.3306. Exceptions to this requirement may be approved by the department or
				its designee.
(6) Except as
				otherwise provided for in this subchapter, a client may select a case
				management service provider and other service providers whose services are
				received with the assistance of case management.
(7) A client in accordance with the following
				criteria may temporarily receive case management services from more than one
				case management service provider if:
(a)
				there is need for more than one case manager to manage the provision of
				services to the client;
(b) there
				is a single coordinated individualized plan for case management of the
				provision of services;
(c) there is
				a lead case management provider;
(d) there is an agreement as to which case
				management services provider will bill Medicaid; and
(e) the plan of care contains the following:
(i) designation of the lead case management
				service provider;
(ii)
				justification for the use of more than one case management service
				provider;
(iii) specification of
				roles and responsibilities each case management service provider is to
				undertake;
(iv) documentation of
				all the case management services provided on behalf of the client, including
				those not reimbursed by Medicaid;
(v) assurances of nonduplication of case
				management services; and
(vi)
				strategies for reducing case management to a single service provider.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.33 - Case Management Services - General › Rule 37.86.3306 - CASE MANAGEMENT SERVICES, GENERAL ELIGIBILITY

Current through Register Vol. 13, July 5, 2024
(1) Persons who are Medicaid recipients and
				are from the following groups are eligible for case management services:
(a) high risk pregnant women;
(b) adults with severe disabling mental
				illness;
(c) persons age 16 and
				over with developmental disabilities;
(d) youth with serious emotional
				disturbance;
(e) children at risk
				for abuse and neglect; and
(f)
				children with special health care needs.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.34 - Case Management Services for High Risk Pregnant Women › Rule 37.86.3401 - TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The definitions of targeted case management services for
				  high risk pregnant women are as follows:
(1) "Care plan" means a specific written plan
				that is based on the information collected through the comprehensive assessment
				and periodic reassessment that:
(a) specifies
				the goals and actions to address the medical, social, educational, and other
				services needed by the member;
(b)
				includes activities such as ensuring the active participation of the member,
				and working with the member and others to develop those goals; and
(c) identifies a course of action to respond
				to the assessed needs of the member.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.34 - Case Management Services for High Risk Pregnant Women › Rule 37.86.3402 - TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, ELIGIBILITY

Current through Register Vol. 13, July 5, 2024
(1) A member is eligible for targeted case
				management as a high risk pregnant woman if:
(a) the person is receiving Medicaid or is
				presumptively eligible for Medicaid; and
(b) the member's pregnancy outcome is
				considered high risk .
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.34 - Case Management Services for High Risk Pregnant Women › Rule 37.86.3405 - TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, COVERAGE

Current through Register Vol. 13, July 5, 2024
(1) Reimbursable targeted case management
				services for high risk pregnant women are:
(a) comprehensive assessment and periodic
				reassessment;
(b) care plan
				development;
(c) care coordination
				and referral for other services; and
(d) monitoring and follow up.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.34 - Case Management Services for High Risk Pregnant Women › Rule 37.86.3410 - TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, PROVIDER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) These
				requirements are in addition to those requirements contained in rule and
				statutory provisions generally applicable to Medicaid providers.
(2) To be qualified as a provider of targeted
				case management services for high risk pregnant women, an enrolled Montana
				Medicaid provider must:
(a) be approved by
				the department;.
(b) meet the
				requirements in (3) through (8);
(c) have knowledge and experience in the
				delivery of home and community services to high risk pregnant women;
(d) demonstrate an understanding of the
				concept of prenatal care coordination services; and
(e) have developed collaborative working
				relationships with health care and other agencies in the area to be served.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.34 - Case Management Services for High Risk Pregnant Women › Rule 37.86.3411 - CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, FINANCIAL RECORDS, AND REPORTING (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-113,
					 MCA IMP:
					 2-4-201,
					 53-2-201,
					 53-2-606,
					 53-6-101,
					 53-6-111,
					 53-6-113,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.34 - Case Management Services for High Risk Pregnant Women › Rule 37.86.3415 - TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Targeted case management services for
				high risk pregnant women are reimbursed at the lower of the following:
(a) the provider's customary charge to the
				general public for the service; or
(b) the department's current fee schedule
				under ARM 37.85.105.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.35 - Case Management Services for Adults with Severe Disabling Mental Illness › Rule 37.86.3501

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113, MCA; IMP:
					 53-2-201,
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.35 - Case Management Services for Adults with Severe Disabling Mental Illness › Rule 37.86.3502

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113,
					 53-21-703, MCA; IMP:
					 53-6-101,
					 53-21-701,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.35 - Case Management Services for Adults with Severe Disabling Mental Illness › Rule 37.86.3503

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113, MCA; IMP:
					 53-2-201,
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.35 - Case Management Services for Adults with Severe Disabling Mental Illness › Rule 37.86.3505

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113, MCA; IMP:
					 53-2-201,
					 53-6-101,
					 53-6-113,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.35 - Case Management Services for Adults with Severe Disabling Mental Illness › Rule 37.86.3506

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113, MCA; IMP:
					 53-2-201,
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.35 - Case Management Services for Adults with Severe Disabling Mental Illness › Rule 37.86.3507

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-2-201,
					 53-6-113, MCA; IMP:
					 53-2-201,
					 53-6-101,
					 53-6-111,
					 53-6-113,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.35 - Case Management Services for Adults with Severe Disabling Mental Illness › Rule 37.86.3515 - TARGETED CASE MANAGEMENT SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS, REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Targeted case
				management services for adults with severe disabling mental illness will be
				reimbursed on a fee per unit of service basis as follows. For purposes of this
				rule, a unit of service is a period of 15 minutes.
(2) The department adopts and incorporates by
				reference the department's fee schedule which sets forth the reimbursement
				rates for targeted case management. The provider reimbursement rate for
				targeted case management services for adults with severe disabling mental
				illness is stated in the department's fee schedule as provided in ARM 37.85.
				106.
AUTH:
					 53-2-201,
					 53-6-113, MCA; IMP:
					 53-2-201,
					 53-6-101,
					 53-6-113,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.36 - Case Management Services for Persons Age 16 and Over with Developmental Disabilities › Rule 37.86.3601 - CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The definitions of case management services for persons with
				  developmental disabilities age 16 years of age and over are as follows:
(1) "Developmental disability" means a
				disability attributable to mental retardation, cerebral palsy, epilepsy,
				autism, or any other neurological handicapping condition closely related to
				mental retardation and requiring treatment similar to that required by mentally
				retarded persons if the disability originated before the person attained age
				18, has continued or can be expected to continue indefinitely, and constitutes
				a substantial handicap of the person.
(2) "Developmental disabilities program"
				means the program of services administered by the department for persons with
				developmental disabilities.
(3)
				"Intermediate care facility for the mentally retarded (ICF/MR)" means a
				residential facility as defined at
				42 USC
				1396 d(d) and licensed by the Montana
				Department of Public Health and Human Services to provide active treatment
				services to persons with developmental disabilities.
(4) "Nursing facility" means a residential
				facility as defined at
				42 USC
				1396 r(a) and licensed by the Montana
				Department of Public Health and Human Services to provide nursing
				services.
(5) "Monitor" means
				periodic review of the implementation of services identified in the individual
				plan.
(6) "Individual plan (IP)"
				means a written plan developed with the client's participation for the
				provision and management of services in the least restrictive manner to
				recipients. The plan must contain:
(a)
				reference to all provided services including identification of
				providers;
(b) documentation of who
				was involved in developing the plan;
(c) long range services and goals;
(d) short term services and
				objectives;
(e) schedules for
				service initiation and frequency; and
(f) schedules for updating the
				plan.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.36 - Case Management Services for Persons Age 16 and Over with Developmental Disabilities › Rule 37.86.3602 - CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, ELIGIBILITY

Current through Register Vol. 13, July 5, 2024
(1)
				A person is eligible for case management as a person with developmental
				disabilities if the person:
(a) is receiving
				Medicaid;
(b) is 16 years of age or
				over; and
(c) has a developmental
				disability.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.36 - Case Management Services for Persons Age 16 and Over with Developmental Disabilities › Rule 37.86.3603 and 37.86.3604 - Reserved

Current through Register Vol. 13, July 5, 2024
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.36 - Case Management Services for Persons Age 16 and Over with Developmental Disabilities › Rule 37.86.3605 - CASE MANAGEMENT SERVICES FOR PERSONS AGE 16 AND OVER WITH DEVELOPMENTAL DISABILITIES, COVERAGE

Current through Register Vol. 13, July 5, 2024
(1)
				Reimbursable case management services for persons age 16 and over with
				developmental disabilities are:
(a) service
				coordination which includes the following:
(i) assessment and evaluation of the
				appropriateness and need for case management and other community services for
				which the client might be eligible;
(ii) assistance in accessing and obtaining
				needed services as requested by the client;
(iii) assisting the client's entry into
				services; and
(iv) monitoring and
				follow up services received by the client.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.36 - Case Management Services for Persons Age 16 and Over with Developmental Disabilities › Rule 37.86.3606 - CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, PROVIDER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) These
				requirements are in addition to those contained in rule and statutory
				provisions generally applicable to Medicaid providers.
(2) The case management provider for persons
				age 16 and over with developmental disabilities is the Developmental
				Disabilities program of the department. The program may contract for the
				delivery of case management services.
(3) Contractors with the program for the
				provision of case management services must be either accredited by one of the
				national accreditation agencies for developmental disabilities services
				specified in ARM
				37.34.1801 or licensed under
				50-5-201,
				MCA as a health care facility by the department.
(4) A case manager must be employed by the
				Developmental Disabilities program of the department or by a case management
				provider contracting with the program.
(5) A case manager must meet the following
				criteria:
(a) A case manager, except as
				otherwise provided for in (5)(b), must:
(i)
				have a bachelor's degree in social work or a related field from an accredited
				college; and
(ii) one year
				experience in developmental disabilities or other human services:
(A) if the experience is in a human service
				other than developmental disabilities, the case manager must have completed at
				least 40 hours of training in the delivery of services to persons with
				developmental disabilities under a training curriculum reviewed by the
				developmental disabilities program of the department within no more than three
				months of hire or designation as a case manager.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.36 - Case Management Services for Persons Age 16 and Over with Developmental Disabilities › Rule 37.86.3607 - CASE MANAGEMENT SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1)
				Reimbursement for the delivery by provider entities of Medicaid funded targeted
				case management services to persons with developmental disabilities is provided
				as specified in the Montana Developmental Disabilities Program Manual of
				Service Reimbursement Rates and Procedures for Targeted Case Management
				Services for Individuals with Developmental Disabilities Enrolled in the
				1915(c) 0208 Home and Community Based (HCBS) Comprehensive Waiver or Eligible
				Individuals Age 16 and Over, dated July 1, 2023.
(2) The department adopts and incorporates by
				this reference the Montana Developmental Disabilities Program Manual of Service
				Reimbursement Rates and Procedures for Targeted Case Management Services for
				Individuals with Developmental Disabilities Enrolled in the 1915(c) 0208 Home
				and Community Based (HCBS) Comprehensive Waiver or Eligible Individuals Age 16
				and Over, dated July 1, 2023. The manual is posted at
https://dphhs.mt.gov/bhdd/disabilityservices/developmentaldisabilities/ddpratesinf
.
AUTH:
					 53-6-113, MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.37 - Case Management Services for Youth with Serious Emotional Disturbance › Rule 37.86.3701 - CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, DEFINITIONS (REPEALED)

Current through Register Vol. 13, July 5, 2024
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-6-101,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.37 - Case Management Services for Youth with Serious Emotional Disturbance › Rule 37.86.3702 - CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-6-101,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.37 - Case Management Services for Youth with Serious Emotional Disturbance › Rule 37.86.3705 - CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, SERVICE COVERAGE (REPEALED)

Current through Register Vol. 13, July 5, 2024
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-2-201,
					 53-6-101,
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.37 - Case Management Services for Youth with Serious Emotional Disturbance › Rule 37.86.3706 - CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, SERVICE REQUIREMENTS (REPEALED)

Current through Register Vol. 13, July 5, 2024
53-6-113,
					 MCA; IMP,
					 53-2-201,
					 53-6-101,
					 53-6-111,
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.37 - Case Management Services for Youth with Serious Emotional Disturbance › Rule 37.86.3707 - CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, PROVIDER REQUIREMENTS (REPEALED)

Current through Register Vol. 13, July 5, 2024
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-2-201,
					 53-6-101,
					 53-6-111,
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.37 - Case Management Services for Youth with Serious Emotional Disturbance › Rule 37.86.3715 - CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, REIMBURSEMENT (REPEALED)

Current through Register Vol. 13, July 5, 2024
53-2-201,
					 53-6-113,
					 MCA; IMP,
					 53-6-101,
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.38 - Case Management Services for Children at Risk of Abuse and Neglect › Rule 37.86.3801 - CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, DEFINITIONS (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-113,
					 MCA IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.38 - Case Management Services for Children at Risk of Abuse and Neglect › Rule 37.86.3805 - CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, COVERAGE (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-113,
					 MCA IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.38 - Case Management Services for Children at Risk of Abuse and Neglect › Rule 37.86.3806 - MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, ELIGIBILITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-113,
					 MCA IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.38 - Case Management Services for Children at Risk of Abuse and Neglect › Rule 37.86.3810 - MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, PROVIDER REQUIREMENTS (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-113,
					 MCA IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.38 - Case Management Services for Children at Risk of Abuse and Neglect › Rule 37.86.3811 - MEDICAID REIMBURSED CASE MANAGEMENT SERVICES FOR CHILDREN AT RISK OF ABUSE AND NEGLECT, REIMBURSEMENT (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 53-6-113,
					 MCA IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.39 - Case Management Services for Children with Special Health Care Needs › Rule 37.86.3901 - TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The definitions of targeted case management services for
				  children and youth with special health care needs are as follows:
(1) "Care plan" means a specific written plan
				that is based on the information collected through the comprehensive assessment
				and periodic reassessment process that:
(a)
				specifies the goals and actions to address the medical, social, educational,
				and other services needed by the child;
(b) includes activities such as ensuring the
				active participation of the child and child's caregiver and working with the
				child and others to develop those goals; and
(c) identifies a course of action to respond
				to the assessed needs of the child.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.39 - Case Management Services for Children with Special Health Care Needs › Rule 37.86.3902 - TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, ELIGIBILITY

Current through Register Vol. 13, July 5, 2024
(1) A child who is
				receiving Medicaid or is presumptively eligible for Medicaid is eligible for
				targeted case management services for children and youth with special health
				care needs if the child meets one of the requirements in (a) or (b) and meets
				one of the requirements in (c).
(a) The child
				is under the age of one and meets one of the following:
(i) was born to a mother who abused drugs or
				alcohol during her pregnancy;
(ii)
				was born prior to 37 weeks gestation;
(iii) was born at a birth weight of less than
				2500 grams; or
(iv) the department
				has care and placement authority, a voluntary services agreement, an in-home
				service agreement or a voluntary placement agreement with the
				parent/guardians.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.39 - Case Management Services for Children with Special Health Care Needs › Rule 37.86.3905 - TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, COVERAGE

Current through Register Vol. 13, July 5, 2024
(1) The following
				services are reimbursable targeted case management services for children and
				youth with special health care needs:
(a)
				comprehensive assessment and periodic reassessment;
(b) care plan development;
(c) care coordination and referral for other
				services; and
(d) monitoring and
				follow up.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.39 - Case Management Services for Children with Special Health Care Needs › Rule 37.86.3906 - TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, PROVIDER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1)
				These requirements are in addition to those contained in rule and statutory
				provisions generally applicable to medicaid providers.
(2) To be qualified as a provider of targeted
				case management services for children and youth with special health care needs,
				an enrolled Montana Medicaid provider must:
(a) be approved by the department;
(b) meet the requirements in (3) through (8);
(c) have knowledge and experience
				in the delivery of home and community services to children and youth with
				special health care needs;
(d)
				demonstrate an understanding of service coordination for children up to 18
				years of age; and
(e) have
				developed collaborative working relationships with health care and other
				providers in the area to be served.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.39 - Case Management Services for Children with Special Health Care Needs › Rule 37.86.3910 - TARGETED CASE MANAGEMENT SERVICES FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Targeted
				case management services for children and youth with special health care needs
				are reimbursed at the lower of the following:
(a) the provider's customary charge to the
				general public for the service; or
(b) the department's current fee schedule
				under ARM 37.85.105.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.40 - Targeted Case Management Services for Substance Use Disorders › Rule 37.86.4001 - TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Adult" means a person 21 years of age or
				older.
(2) "Assessment" and
				"periodic reassessment" means determining the need for any medical,
				educational, social, or other services. These assessment activities include the
				following:
(a) taking client
				history;
(b) identifying the needs
				of the individual and completing related documentation;
(c) gathering information from other sources,
				such as family members, medical providers, social workers, and educators (if
				necessary) to form a complete assessment of the eligible individual.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.40 - Targeted Case Management Services for Substance Use Disorders › Rule 37.86.4002 - TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, ELIGIBILITY

Current through Register Vol. 13, July 5, 2024
(1) TCM services are available under ARM
				37.86.4001,
				37.86.4002,
				37.86.4005,
				37.86.4006,
				37.86.4007, and
				37.86.4010 only to persons who
				meet the following criteria:
(a) Youth who
				are 20 years of age or younger with a diagnosis of substance dependency or
				substance abuse.
(b) Adults who are
				21 years of age or older with a diagnosis of substance dependency.