Mont. Admin. r. 37.57.117

Current through Register Vol. 1, January 10, 2025

Rule 37.57.117 - CSHS PROVIDERS RECEIVING CSHS FUNDS: REQUIREMENTS

(1) In order to be a CSHS provider for a CSHS client, a provider must meet the following requirements:

(a) A physician or surgeon must:

(i) be currently licensed by the state of Montana pursuant to Title 37, chapter 3, MCA, or currently licensed to practice medicine in the state in which they reside;

(ii) provide the department, upon request, with adequate documentation of credentials needed to prove program eligibility.

(b) An orthodontist must:

(i) be currently licensed as a dentist in the state of Montana or the state of residence;

(ii) have completed two years of graduate or post-graduate orthodontic training recognized by the council of dental education of the American dental association or the American orthodontic association; and

(iii) limit their practice to the area of orthodontics.

(c) A pediatric dentist may treat a CYSHCN under the age of ten for orthodontia and must:

(i) be currently licensed as a dentist by the state of Montana or the state of residence; and

(ii) have completed a minimum of two academic years of a graduate or post-graduate pediatric dentistry program accredited by the council on dental accreditation of the American dental association.

(d) A hospital must be accredited by the joint commission of accreditation of healthcare organizations and be currently licensed and certified by the department, if in-state, or by the state in which it is located, if out-of-state.

(e) Any provider other than those listed in (1)(a) through (1)(d) must be certified and/or licensed by the appropriate Montana authority, or if Montana has no certification or licensure requirements for the provider, be certified by a nationally recognized professional organization in the provider's area of expertise.

(2) A provider must immediately supply the department with requested reports to permit effective evaluation of claims.

(3) A provider must accept CSHS level of payment for services and may not seek additional payment from a CSHS client or family.

Mont. Admin. r. 37.57.117

NEW, 1990 MAR p. 1256, Eff. 6/29/90; AMD, 1992 MAR p. 919, Eff. 5/1/92; TRANS, from DHES, 2001 MAR p. 398; AMD, 2003 MAR p. 1637, Eff. 8/1/03; AMD, 2012 MAR p. 1672, Eff. 8/24/12; REP, 2016 MAR p. 1855, Eff. 10/15/2016; AMD, 2018 MAR p. 1733, Eff. 8/25/2018

AUTH: 50-1-202, MCA; IMP: 50-1-202, MCA