Rule 37.86.3415 - TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, REIMBURSEMENT(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.(2) The following activities may not be billed as targeted case management and are not reimbursable as a unit of targeted case management: (a) outreach to the member or member's representative;(b) application activities related to Medicaid services or eligibility;(c) direct medical services, including counseling or the transportation or escort of members;(d) duplicate payments that are made to providers under Medicaid or other program authorities;(e) writing, recording, or entering case notes for the member's files;(f) travel to and from member activities;(g) coordination of the investigation of any suspected abuse, neglect, or exploitation cases; and(h) any service less than eight minutes duration if it is the only service provided that day.(3) Targeted case management services are not separately billable for members enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program.(4) All targeted case management services must meet the guidelines of medical necessity set forth in ARM 37.85.410.Mont. Admin. r. 37.86.3415
NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1996 MAR p. 1997, Eff. 6/7/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/2017AUTH: 53-6-113, MCA; IMP: 53-6-101, MCA