Mont. Admin. R. 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.
Notes
AUTH: 53-6-113, MCA; IMP: 53-6-101, MCA
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