Mont. Admin. R. 37.40.1026 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: REIMBURSEMENT
(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.
(2) Add-on payments for
direct-care wage, bonus, and health care for health care workers are as
described in ARM
37.40.1027 and
37.40.1030.
(3) CFCS include the following:
(a) personal care attendant service is a
15-minute unit and means an onsite visit specific to a member. Personal care
attendant services include the performance of activities of daily living,
instrumental activities of daily living, skill acquisition, maintenance, and
enhancement services. The personal care attendant service rate is an
all-inclusive rate and includes the provider agency's administrative,
person-centered planning, supervision, and oversight duties;
(b) medical escort is a 15-minute unit and
means transportation time and appointment time so the person can access an
approved medical appointment;
(c)
mileage is a unit of one mile and means reimbursement for mileage when an
attendant uses their vehicle to transport a person on an approved shopping,
community integration, or medical escort trip; and
(d) personal emergency response is a unit of
service that covers the initial installation fee and monthly rental fee of the
unit.
(4) The department
will not reimburse a member for in-home services delivered by a privately
retained attendant.
(5)
Reimbursement is not available for CFCS provided by immediate family members as
described in ARM
37.40.1002.
(6) Reimbursement fees for agency-based and
self-directed CFCS are stated in the department's fee schedule adopted at ARM
37.85.105(4).
Notes
AUTH: 53-2-201, MCA; IMP: 53-2-201, 53-6-113, MCA
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