reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.8 - Hospice › Rule 37.40.806 - HOSPICE, COVERED SERVICES

Current through Register Vol. 13, July 5, 2024
(1) To be
				covered, hospice services must meet the following requirements:
(a) they must be reasonable and necessary for
				the palliation or management of the terminal illness as well as related
				conditions;
(b) the beneficiary
				must elect hospice care in accordance with ARM
				37.40.815;
(c) a plan of care must be established as set
				forth in ARM
				37.40.805
				and
				37.40.807
				before services are provided. The services must be consistent with the plan of
				care; and
(d) a certification that
				the beneficiary is terminally ill must be completed as set forth in ARM
				37.40.808.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.8 - Hospice › Rule 37.40.807 - HOSPICE CONDITION OF PARTICIPATION: INTERDISCIPLINARY GROUP, CARE PLANNING, AND COORDINATION OF SERVICES (REPEALED)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 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.8 - Hospice › Rule 37.40.808 - HOSPICE, CERTIFICATION OF TERMINAL ILLNESS

Current through Register Vol. 13, July 5, 2024
(1) In order to be eligible to elect hospice
				care under Medicaid, a beneficiary must be certified as being terminally ill in
				accordance with Medicare certification requirements under
				42 CFR
				418.22.
AUTH:
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.8 - Hospice › Rule 37.40.815 - HOSPICE, ELECTION AND WAIVER OF OTHER BENEFITS

Current through Register Vol. 13, July 5, 2024
(1) A beneficiary eligible for hospice care
				or their representative must file an election statement with a particular
				hospice in order to receive such care. The department will follow Medicare
				regulations and guidelines in administering this provision, including
				42 CFR
				418.20 through
				418.30.
(2) A beneficiary waives all rights to
				Medicaid payments for the duration of the election of hospice care for the
				following services:
(a) Hospice care provided
				by a hospice other than the hospice designated by the beneficiary (unless
				provided under arrangements made by the designated hospice).
(b) Any Medicaid services that are related to
				the treatment of the terminal condition for which hospice care was elected or a
				related condition or that are equivalent to hospice care except for:
(i) services provided by the designated
				hospice;
(ii) services provided by
				another hospice under arrangements made by the designated hospice;
				and
(iii) services provided by the
				beneficiary's attending physician if that physician is not an employee of the
				designated hospice or receiving compensation from the hospice for those
				services.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.8 - Hospice › Rule 37.40.816 - HOSPICE, REVOCATION OF ELECTION

Current through Register Vol. 13, July 5, 2024
(1) A
				beneficiary or their representative may revoke the beneficiary's election of
				hospice care at any time during an election period. The department will follow
				Medicare regulations and guidelines in administering this provision, including
				42 CFR
				418.28.
(2) When the hospice election is ended due to
				revocation, the hospice must file a Notice of Revocation of Election with the
				department within five calendar days after the effective date of the
				revocation, unless it has already filed a final claim for that beneficiary. A
				Notice of Revocation must be sent to the Senior & Long Term Care Division,
				1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210.
AUTH:
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.8 - Hospice › Rule 37.40.825 - HOSPICE, CHANGE OF HOSPICE

Current through Register Vol. 13, July 5, 2024
(1) A
				beneficiary or their representative may change once in each election period the
				designation of the particular hospice from which hospice care will be received.
				The department will follow Medicare regulations and guidelines in administering
				this provision, including
				42 CFR
				418.30.
AUTH:
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 MCA
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.8 - Hospice › Rule 37.40.830 - HOSPICE, REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Medicaid
				payment for covered hospice care will be made in accordance with the specific
				categories of covered hospice care and the payment amounts and procedures
				established by Medicare under
				42 CFR
				418.301 through
				418.312. The specific categories
				of covered hospice care include:
(a) routine
				home care day;
(b) continuous home
				care day;
(c) inpatient respite
				care day;
(d) general inpatient
				care day; and
(e) service intensity
				add-on.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.9 - Home Dialysis for End Stage Renal Disease › Rule 37.40.901 - HOME DIALYSIS FOR END STAGE RENAL DISEASE, DEFINITION

Current through Register Vol. 13, July 5, 2024
(1) Home dialysis service for end stage renal
				disease is the provision of equipment required for the renal dialysis of a
				recipient in his home.
(a) Related services
				includes training at a certified home dialysis training center for a recipient
				and a "back-up" person, if necessary, in dialysing a patient at home.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.9 - Home Dialysis for End Stage Renal Disease › Rule 37.40.902 - HOME DIALYSIS FOR END STAGE RENAL DISEASE, REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
These requirements are in addition to those contained in ARM
				  37.85.401,
				  37.85.402,
				  37.85.406,
				  37.85.407,
				  37.85.410 and
				  37.85.414.
(1) The provision of home dialysis and
				related services by the medicaid program shall be coordinated with the Title
				XVIII medicare renal disease program and any other program providing the same
				or similar service. Application for medicare benefit is required if medicaid
				coverage is to be allowed.
(2) Any
				interest in equipment accrued by means of lease or purchase by the department
				shall be retained by the department. In no case will a recipient have or be
				entitled to any property interest in the equipment leased or
				purchased.
(3) Home dialysis and
				related services shall be provided only to a person who has been diagnosed as
				suffering from chronic end stage renal disease by a physician.
(4) Medical necessity and appropriateness of
				the services shall be subject to review by the designated professional review
				organization.
(5) In all cases
				where feasible and necessary, a member of the recipient's household shall be
				trained as the "back-up" person.
Sec.
					 53-6-113
					 MCA; Sec.
					 53-6-101
					 and
					 53-6-141
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.9 - Home Dialysis for End Stage Renal Disease › Rule 37.40.905 - HOME DIALYSIS FOR END STAGE RENAL DISEASE, REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Reimbursement for equipment shall be the
				lesser of the following:
(a) the provider's
				usual and customary charges which are reasonable; or
(b) the medicaid established fee for that
				service.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1002 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: ELIGIBILITY, SERVICES PROVIDED, AND LIMITATIONS

Current through Register Vol. 13, July 5, 2024
(1) To qualify for
				Community First Choice Services (CFCS), a person must:
(a) be Medicaid eligible;
(b) meet the level of care criteria found at
				ARM 37.40.205(1);
				and
(c) demonstrate a medical and
				functional need for assistance with activities of daily living.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1005 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: PERSON-CENTERED PLAN REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) In order to
				receive Community First Choice Services (CFCS), the member must be capable of
				making choices about activities of daily living and instrumental activities of
				daily living. The member must be able to understand the impact of these choices
				and assume responsibility for the choices. If the member is unable to meet
				these criteria, the member may have someone assist them in decision making and
				directing their activities. The CFCS person-centered planning process includes
				multiple steps to protect a member's health and safety while ensuring that
				member choice and control are an integral component of service delivery. Prior
				to delivering CFCS, the following person-centered planning requirements must be
				met:
(a) a licensed contract nurse must
				complete a functional assessment and service profile;
(b) a plan facilitator must complete the
				person-centered plan; and
(c) a
				nurse supervisor or program oversight staff must complete the service
				plan.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1006 - SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: DESCRIPTION AND PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) Self-directed
				Community First Choice Services (CFCS) are services provided to Medicaid
				members who choose to take the responsibility or have a representative take the
				responsibility of managing the CFCS. Self-directed CFCS allow the member to
				direct CFCS, including health maintenance tasks.
(2) Health maintenance tasks include the
				following:
(a) urinary systems
				management;
(b) bowel
				care;
(c) wound care; and
(d) medication management.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1007 - SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: GENERAL REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) Self-directed
				Community First Choice Services (CFCS) may only be delivered by an attendant
				who is the employee of a Medicaid-enrolled provider and who is selected by the
				member or their personal representative.
(2) Agency-based CFCS managed by provider
				agencies under agreement with Medicaid are not available to members who are
				participating in the self-directed CFCS program. The use of CFCS managed by
				provider agencies may be permissible in the event that the member's backup plan
				fails.
(3) Home health and home and
				community-based waiver skilled nursing services are not available to members
				for the completion of health maintenance activities which the member has been
				authorized to manage. The use of home health and home and community-based
				waiver skilled nursing services may be permissible in the event that the
				member's backup plan fails. In this case the service must be prior
				authorized.
(4) Members who have
				been terminated from the self-directed program may apply for agency-based CFCS
				through the Medicaid CFCS program managed by approved provider
				agencies.
53-2-201,
					 MCA IMP:
					 53-2-201,
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1008 - SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: MEMBER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) To qualify for
				self-directed Community First Choice Services (CFCS), the member:
(a) must be capable of assuming the
				management responsibilities of self-directed CFCS or have a personal
				representative willing to assume this responsibility. Management
				responsibilities include the following:
(i)
				recruit, hire, schedule, train, and dismiss all personal care
				attendants;
(ii) develop a backup
				plan for when a personal care attendant is unable to provide services. The
				backup plan identifies the process for addressing the member's functional need
				for service as identified on the service plan should the personal care
				attendant be unable to deliver services;
(iii) review, approve, sign, and date all
				service delivery records to provide assurance that the service plan has been
				followed; and
(iv) assume medical
				and related liability regarding the delivery of CFCS.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1012 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: TERMINATION FROM SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Community First
				Choice Services (CFCS) may be terminated for any of the following reasons:
(a) the member, or other persons in the
				household, subjects the direct-care worker to physical or verbal abuse, sexual
				harassment, exposure to the use of illegal substances, or to threats of
				physical harm;
(b) the member
				requests termination of services or refuses to accept help;
(c) the environment of the member is unsafe
				for the provision of CFCS;
(d) the
				member is engaging in illegal activity in the home;
(e) the member's physician requests
				termination of services;
(f) the
				member no longer has a medical need for CFCS;
(g) the member refuses the services of a
				direct-care worker based solely or partly on the attendant's race, creed,
				religion, sex, marital status, color, age, handicap, or national
				origin;
(h) the member refuses to
				accept services in compliance with the service plan;
(i) the member refuses to participate in the
				functional assessment, recertification, and person-centered planning visits;
				or
(j) the member falsifies the
				service delivery record.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1013 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: PROVIDER ENROLLMENT

Current through Register Vol. 13, July 5, 2024
(1) Providers will
				enroll as a Community First Choice Services (CFCS) personal care attendant
				provider, a CFCS personal emergency response system (PERS) provider, or both.
				Providers must enroll through the department's fiscal intermediary.
(2) CFCS providers must be businesses
				incorporated under the laws of the state of Montana.
(3) CFCS providers must submit a description
				of the proposed service area which must include, at a minimum, coverage of the
				entire area of at least one county or Indian reservation.
(4) CFCS personal care attendant service
				providers must comply with onsite visit requirements both before and after
				enrollment to verify information submitted to the department.
(5) CFCS personal care attendant service
				providers must provide the documentation to demonstrate the following:
(a) general liability insurance with a
				minimum coverage of $1,000,000 per occurrence and $2,000,000
				aggregate;
(b) motor vehicle
				liability insurance with split limits of $500,000 per person for personal
				injury, $1,000,000 per accident occurrence for personal injury, and $100,000
				per accident occurrence for property damage; or, combined single limits of
				$1,000,000 per occurrence to cover such claims as may be caused by any act,
				omission, or negligence of the provider or its agents, officers,
				representatives, assigns, or subcontractors;
(c) current unemployment insurance and
				workers' compensation coverage; and
(d) verification of completion of the
				department's mandatory CFCS training.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1016 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: CONFLICT OF INTEREST CRITERIA

Current through Register Vol. 13, July 5, 2024
(1) In order to
				perform the duties of an agency-based nurse supervisor, self-directed program
				oversight staff, or the Community First Choice Services (CFCS) provider
				person-centered plan facilitator the person cannot:
(a) be related by blood or marriage to the
				member or to any paid caregiver for the member;
(b) be financially responsible to the
				member;
(c) have authority to make
				financial or health-related decisions on behalf of the member;
(d) benefit financially from the provision of
				assessed need for services;
(e) be
				employed as a direct-care worker at the agency; or
(f) have a majority ownership stake in the
				agency.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1017 - AGENCY-BASED COMMUNITY FIRST CHOICE SERVICES: PROVIDER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) Providers may enroll as a Community First
				Choice Services (CFCS) personal care attendant provider, a CFCS personal
				emergency response system provider, or both.
(2) CFCS personal care attendant providers
				will maintain staff resources, including a nurse supervisor and person-centered
				plan facilitator, to perform the necessary CFCS duties as referenced in ARM
				37.40.1005. The nurse supervisor
				and plan facilitator may be the same person.
(3) CFCS nurse supervisors must meet the
				following criteria:
(a) be a licensed
				nurse;
(b) have at least one year's
				experience in aging and disability services;
(c) receive training in CFCS; and
(d) be free of conflict-of-interest criteria
				as referenced in ARM
				37.40.1016.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1018 - SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: PROVIDER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) Self-directed Community First Choice
				Services (CFCS) providers must employ program oversight staff to perform the
				following self-directed oversight activities:
(a) assist members to identify resources for
				personal assistants;
(b) advise the
				member regarding program requirements;
(c) complete compliance documentation and
				follow-up if the member does not comply with program requirements;
				and
(d) provide documentation to
				ensure that the personal representative meets the participation criteria
				described in ARM
				37.40.1008.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1022 - AGENCY-BASED COMMUNITY FIRST CHOICE SERVICES: PROVIDER COMPLIANCE

Current through Register Vol. 13, July 5, 2024
(1) Providers of
				Community First Choice Services (CFCS) will be subject to compliance reviews to
				provide assurance to the department that services are being provided within the
				rules and policy of the program.
(2) The department will conduct compliance
				reviews on the provider's premises and through documentation requests. The
				provider must supply documentation requested by the department in a reasonable
				time frame and no later than 30 days following the request.
(3) The reviews will take place at times
				determined by the department.
(4)
				The department will determine compliance in the following service delivery
				areas:
(a) service authorization
				documentation;
(b) high-risk
				authorization;
(c) amendments and
				temporary authorization;
(d)
				service plan and member choice;
(e)
				service delivery;
(f) nurse
				supervision and oversight; and
(g)
				health and welfare and serious occurrence reports.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1023 - SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: PROVIDER COMPLIANCE

Current through Register Vol. 13, July 5, 2024
(1) Providers of
				Community First Choice Services (CFCS) will be subject to compliance reviews to
				provide assurance to the department that services are being provided within the
				rules and policy of the program.
(2) The department will conduct compliance
				reviews on the provider's premises and through documentation requests. The
				provider must supply documentation requested by the department in a reasonable
				time frame and no later than 30 days following the request.
(3) The reviews will take place at times
				determined by the department.
(4)
				The department will determine compliance in the following service delivery
				areas:
(a) service authorization
				documentation;
(b) health-care
				professional authorization;
(c)
				high-risk authorization;
(d)
				amendments and temporary authorization;
(e) service plan and member choice;
(f) service delivery;
(g) agency program oversight; and
(h) health and welfare and serious occurrence
				reports.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1026 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Community First
				Choice Services (CFCS) may be provided up to, but not more than, 84 hours of
				attendant service per two-week time period per person as defined by the service
				profile. The department may, within its discretion, authorize additional hours
				in excess of this limit. Any services exceeding this limit must be prior
				authorized by the department. Prior authorization for excess hours may be
				authorized if additional assistance is required for:
(a) a period of time not to exceed three
				months and as the result of an acute medical episode;
(b) a period of time not to exceed three
				months and to prevent institutionalization during the absence of the normal
				caregiver; or
(c) a period of time
				not to exceed three months and during a post-hospitalization period.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1027 - ADD-ON PAYMENTS AND REPORTING REQUIREMENTS FOR DIRECT-CARE WORKERS' WAGE AND LUMP-SUM PAYMENTS

Current through Register Vol. 13, July 5, 2024
(1) In addition to
				the reimbursement fee as provided in ARM 37.40.1026, 37.40.1030,
				37.40.1105, and
				37.85.105 the department will pay
				Medicaid personal assistance service and Community First Choice Services (CFCS)
				providers located in Montana who submit an approved request to the department,
				an add-on payment. Add-on payment is used only for wage and benefit increases
				or lump-sum payments for direct-care workers who deliver Medicaid personal
				assistance or CFCS.
(a) The department will
				determine the add-on payments, commencing July 1, 2014, as a pro rata share of
				appropriated funds available for increases in direct-care worker wages,
				lump-sum direct-care worker bonus payments, or both. A provider agency is
				eligible to receive a portion of the total funds based on their percentage of
				total utilization of personal assistance services and CFCS over the previous
				fiscal year.
(b) To receive the
				direct-care services workers' add-on payment, a provider must submit for
				approval an application request to the department stating how the direct-care
				workers' wage increase, add-on payment, or both will be spent to comply with
				the requirements outlined in the application. The provider must submit all of
				the information required on a department-approved form in order to continue to
				receive subsequent add-on payment amounts for the entire year.
(c) A provider must submit a qualifying
				request for the funds distributed under (1). The request must include all
				required information, within the deadlines established by the department.
				Providers who do not submit the qualifying request, or do not wish to
				participate in the add-on funding, may not be entitled to their pro rata share
				of the funds available for wage and benefit increase or lump-sum payments for
				direct-care workers.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.10 - Community First Choice Services › Rule 37.40.1030 - ADD-ON PAYMENTS AND REPORTING REQUIREMENTS FOR HEALTH CARE WORKERS

Current through Register Vol. 13, July 5, 2024
(1) The department
				will pay Medicaid Personal Assistance Services and Community First Choice
				Services (CFCS) providers located in Montana, who submit an approved request to
				the department, an add-on payment in addition to the reimbursement fee as
				provided in ARM 37.40.1026, 37.40.1027,
				37.40.1105,
				37.85.105. The add-on payment is
				to be used only to cover health insurance payments for direct-care workers who
				spend a majority of their time serving Medicaid personal care members.
(a) The department will determine the add-on
				payments, commencing July 1, 2014, as a pro rata share of appropriated funds
				allocated for health care for health care worker coverage. A provider agency is
				eligible to receive a portion of the total funds based on their percentage of
				total utilization of personal assistance services and CFCS over the previous
				fiscal year.
(b) To receive the
				health care for health care worker payment, a provider must submit for approval
				an application request to the department stating how the health care for health
				care worker add-on payment will be spent to comply with the application's
				requirements. The provider must submit all of the information required on a
				department-approved form in order to continue to receive subsequent add-on
				payment amounts for the entire year.
(c) A provider must submit an application
				request for the funds distributed under (1)(b). The request must include all
				required information, within the deadlines established by the department.
				Providers who do not submit the application request or do not wish to
				participate in the add-on funding may not be entitled to their pro rata share
				of the funds available for health care for health care worker
				coverage.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1101 - PERSONAL CARE, SERVICES, SERVICES PROVIDED AND LIMITATIONS (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113
					 and
					 53-6-201,
					 MCA; IMP: Sec.
					 53-6-101,
					 53-6-131
					 and
					 53-6-141,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1102 - PERSONAL CARE SERVICES, REQUIREMENTS (Repealed)

Current through Register Vol. 13, July 5, 2024
53-2-201
					 and
					 53-6-113,
					 MCA; IMP: Sec.
					 53-6-101,
					 53-6-131
					 and
					 53-6-141,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1105 - PERSONAL CARE SERVICES, AGENCY-BASED REIMBURSEMENT (Repealed)

Current through Register Vol. 13, July 5, 2024
53-2-201,
					 53-6-101,
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 53-6-141,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1106 - PERSONAL CARE SERVICES, PROVIDER COMPLIANCE (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-101,
					 53-6-113
					 and
					 53-2-201,
					 MCA; IMP: Sec.
					 53-6-101
					 and
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1111 - AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: ELIGIBILITY, SERVICES PROVIDED, AND LIMITATIONS

Current through Register Vol. 13, July 5, 2024
(1) To qualify for
				Personal Assistance Services (PAS), a person must:
(a) be Medicaid eligible; and
(b) demonstrate a medical and functional need
				for assistance with activities of daily living.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1114 - AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PERSON-CENTERED PLAN REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) In order to
				receive Personal Assistance Services (PAS), the member must be capable of
				making choices about activities of daily living and instrumental activities of
				daily living. The member must be able to understand the impact of these choices
				and assume responsibility for the choices. If the member is unable to meet
				these criteria, the member may have someone assist them in decision making and
				directing their activities. The PAS person-centered planning process includes
				multiple steps to protect a member's health and safety while ensuring that
				member choice and control are an integral component of service delivery. Prior
				to delivering PAS, the following person-centered planning requirements must be
				met:
(a) a licensed contract nurse must
				complete a functional assessment and service profile;
(b) a plan facilitator must complete the
				person-centered plan; and
(c) a
				nurse supervisor or program oversight staff must complete the service
				plan.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1115 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: DESCRIPTION AND PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) Self-directed
				Personal Assistance Services (PAS) are services provided to Medicaid members
				who choose to take the responsibility or have a representative take the
				responsibility of managing the PAS. Self-directed PAS allow the member to
				direct PAS, including health maintenance tasks.
(2) Health maintenance tasks include the
				following:
(a) urinary systems
				management;
(b) bowel
				care;
(c) wound care; and
(d) medication management.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1116 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: GENERAL REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) Self-directed
				Personal Assistance Services (PAS) may only be delivered by an attendant who is
				the employee of a Medicaid-enrolled provider and who is selected by the member
				or their personal representative.
(2) Agency-based PAS managed by provider
				agencies under agreement with Medicaid are not available to members who are
				participating in the self-directed PAS program. The use of PAS managed by
				provider agencies may be permissible in the event that the member's backup plan
				fails.
(3) Home health and home and
				community-based waiver skilled nursing services are not available to members
				for the completion of health maintenance activities which the member has been
				authorized to manage. The use of home health and home and community-based
				waiver skilled nursing services may be permissible in the event that the
				member's backup plan fails. In this case the service must be prior
				authorized.
(4) Members who have
				been terminated from the self-directed program may apply for agency-based PAS
				through the Medicaid PAS program managed by approved provider
				agencies.
53-2-201,
					 53-6-101,
					 MCA; IMP:
					 53-2-201,
					 53-6-113,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1117 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: MEMBER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) To qualify for
				self-directed Personal Assistance Services (PAS), the member:
(a) must be capable of assuming the
				management responsibilities of self-directed PAS or have a personal
				representative willing to assume this responsibility. Management
				responsibilities include the following:
(i)
				recruit, hire, schedule, train, and dismiss all personal care
				attendants;
(ii) develop a backup
				plan for when a personal care attendant is unable to provide services. The
				backup plan identifies the process for addressing the member's functional need
				for service as identified on the service plan should the personal care
				attendant be unable to deliver services;
(iii) review, approve, sign, and date all
				service delivery records to provide assurance that the service plan has been
				followed; and
(iv) assume medical
				and related liability regarding the delivery of PAS.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1121 - AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: TERMINATION OF SERVICES

Current through Register Vol. 13, July 5, 2024
(1) Personal
				Assistance Services (PAS) may be terminated for any of the following reasons:
(a) the member, or other persons in the
				household, subjects the direct-care worker to physical or verbal abuse, sexual
				harassment, exposure to the use of illegal substances, or to threats of
				physical harm;
(b) the member
				requests termination of services or refuses to accept help;
(c) the environment of the member is unsafe
				for the provision of PAS;
(d) the
				member is engaging in illegal activity in the home;
(e) the member's physician requests
				termination of services;
(f) the
				member no longer has a medical need for PAS;
(g) the member refuses the services of a
				direct-care worker based solely or partly on the attendant's race, creed,
				religion, sex, marital status, color, age, handicap, or national
				origin;
(h) the member refuses to
				accept services in compliance with the service plan;
(i) the member refuses to participate in the
				functional assessment, recertification, and person-centered planning visits;
				or
(j) the member falsifies the
				service delivery record.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1122 - AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PROVIDER ENROLLMENT

Current through Register Vol. 13, July 5, 2024
(1) Providers will
				enroll as a Personal Assistance Services (PAS) personal care attendant
				provider. Providers must enroll through the department's fiscal intermediary.
(2) PAS providers must be
				businesses incorporated under the laws of the state of Montana.
(3) PAS providers must submit a description
				of the proposed service area which must include, at a minimum, coverage of the
				entire area of at least one county or Indian reservation.
(4) PAS providers must comply with onsite
				visit requirements both before and after enrollment to verify information
				submitted to the department.
(5)
				PAS providers must provide the documentation to demonstrate the following:
(a) general liability insurance with a
				minimum coverage of $1,000,000 per occurrence and $2,000,000
				aggregate;
(b) motor vehicle
				liability insurance with split limits of $500,000 per person for personal
				injury, $1,000,000 per accident occurrence for personal injury, and $100,000
				per accident occurrence for property damage; or, combined single limits of
				$1,000,000 per occurrence to cover such claims as may be caused by any act,
				omission, or negligence of the provider or its agents, officers,
				representatives, assigns, or subcontractors;
(c) current unemployment insurance and
				workers' compensation coverage; and
(d) verification of completion of the
				department's mandatory PAS training.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1125 - AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: CONFLICT-OF-INTEREST CRITERIA

Current through Register Vol. 13, July 5, 2024
(1) In order to
				perform the duties of an agency-based nurse supervisor, self-directed program
				oversight staff, or the Personal Assistance Services (PAS) provider
				person-centered plan facilitator the person cannot:
(a) be related by blood or marriage to the
				member or to any paid caregiver for the member;
(b) be financially responsible to the
				member;
(c) have authority to make
				financial or health-related decisions on behalf of the member;
(d) benefit financially from the provision of
				assessed need for services;
(e) be
				employed as a direct-care worker at the agency; or
(f) have a majority ownership stake in the
				agency.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1126 - AGENCY-BASED PERSONAL ASSISTANCE SERVICES: PROVIDER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) Providers may
				enroll as a Personal Assistance Services (PAS) personal care attendant
				provider.
(2) PAS providers will
				maintain staff resources, including a nurse supervisor and person-centered plan
				facilitator, to perform the necessary PAS duties as referenced in ARM
				37.40.1114. The nurse supervisor and plan facilitator may be the same
				person.
(3) PAS nurse supervisors
				must meet the following criteria:
(a) be a
				licensed nurse;
(b) have at least
				one year's experience in aging and disability services;
(c) receive training in PAS; and
(d) be free of conflict-of-interest criteria
				as referenced in ARM 37.40.1125.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1127 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PROVIDER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) Self-directed Personal Assistance
				Services (PAS) providers must employ program oversight staff to perform the
				following self-directed oversight activities:
(a) assist members to identify resources for
				personal assistants;
(b) advise the
				member regarding program requirements;
(c) complete compliance documentation and
				follow-up if the member does not comply with program requirements;
				and
(d) provide documentation to
				ensure that the personal representative meets the participation criteria
				described in ARM
				37.40.1117.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1131 - AGENCY-BASED PERSONAL ASSISTANCE SERVICES: PROVIDER COMPLIANCE

Current through Register Vol. 13, July 5, 2024
(1) Providers of
				Personal Assistance Services (PAS) will be subject to compliance reviews to
				provide assurance to the department that services are being provided within the
				rules and policy of the program.
(2) The department will conduct compliance
				reviews on the provider's premises and through documentation requests. The
				provider must supply documentation requested by the department in a reasonable
				time frame and no later than 30 days following the request.
(3) The reviews will take place at times
				determined by the department.
(4)
				The department will determine compliance in the following service delivery
				areas:
(a) service authorization
				documentation;
(b) high-risk
				authorization;
(c) amendments and
				temporary authorization;
(d)
				service plan and member choice;
(e)
				service delivery;
(f) nurse
				supervision and oversight; and
(g)
				health and welfare and serious occurrence reports.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1132 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: PROVIDER COMPLIANCE

Current through Register Vol. 13, July 5, 2024
(1) Providers of
				self-directed Personal Assistance Services (PAS) will be subject to compliance
				reviews to provide assurance to the department that services are being provided
				within the rules and policy of the program.
(2) The department will conduct compliance
				reviews on the provider's premises and through documentation requests. The
				provider must supply documentation requested by the department in a reasonable
				time frame and no later than 30 days following the request.
(3) The reviews will take place at times
				determined by the department.
(4)
				The department will determine compliance in the following service delivery
				areas:
(a) service authorization
				documentation;
(b) health-care
				professional authorization;
(c)
				high-risk authorization;
(d)
				amendments and temporary authorization;
(e) service plan and member choice;
(f) service delivery;
(g) agency program oversight; and
(h) health and welfare and serious occurrence
				reports.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.11 - Personal Assistance Services › Rule 37.40.1135 - AGENCY-BASED AND SELF-DIRECTED PERSONAL ASSISTANCE SERVICES: REIMBURSEMENT

Current through Register Vol. 13, July 5, 2024
(1) Personal
				Assistance Services (PAS) may be provided up to, but not more than, 80 hours of
				attendant service per two-week time period per person as defined by the service
				profile. The department may, within its discretion, authorize additional hours
				in excess of this limit. Any services exceeding this limit must be prior
				authorized by the department. Prior authorization for excess hours may be
				authorized if additional assistance is required for:
(a) a period of time not to exceed three
				months and as the result of an acute medical episode;
(b) a period of time not to exceed three
				months and to prevent institutionalization during the absence of the normal
				caregiver; or
(c) a period of time
				not to exceed three months and during a post-hospitalization period.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.13 - Self-Directed Personal Assistance Services › Rule 37.40.1301 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, DESCRIPTION AND PURPOSE (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113
					 and
					 53-6-145,
					 MCA; IMP: Sec.
					 53-6-101
					 and
					 53-6-145,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.13 - Self-Directed Personal Assistance Services › Rule 37.40.1302 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, APPLICATION OF GENERAL PERSONAL CARE RULES (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113,
					 53-6-145,
					 MCA; IMP:
					 53-6-101,
					 53-6-145,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.13 - Self-Directed Personal Assistance Services › Rule 37.40.1303 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, REIMBURSEMENT (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113,
					 MCA; IMP:
					 53-6-101,
					 53-6-145,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.13 - Self-Directed Personal Assistance Services › Rule 37.40.1305 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, CONSUMER REQUIREMENTS (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113
					 and
					 53-6-145,
					 MCA; IMP: Sec.
					 53-6-101
					 and
					 53-6-145,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.13 - Self-Directed Personal Assistance Services › Rule 37.40.1306 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, PLAN OF CARE REQUIREMENTS (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113
					 and
					 53-6-145,
					 MCA; IMP: Sec.
					 53-6-101
					 and
					 53-6-145,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.13 - Self-Directed Personal Assistance Services › Rule 37.40.1307 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, PROVIDER REQUIREMENTS (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113
					 and
					 53-6-145,
					 MCA; IMP: Sec.
					 53-6-101
					 and
					 53-6-145,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.13 - Self-Directed Personal Assistance Services › Rule 37.40.1308 - SELF-DIRECTED PERSONAL ASSISTANCE SERVICES, GENERAL REQUIREMENTS (Repealed)

Current through Register Vol. 13, July 5, 2024
53-6-113
					 and
					 53-6-145,
					 MCA; IMP: Sec.
					 53-6-101
					 and
					 53-6-145,
					 MCA;