37.34.3002    REIMBURSEMENT FOR SERVICES: INDIVIDUAL COST PLANS

(1) Authorization for the reimbursement to a provider for the delivery of particular services and items to a person receiving Developmental Disabilities Program (DDP) funded services is based on the implementation of an individual cost plan (ICP) for the person prior to the delivery of those services and items.

(2) Total reimbursement for the services and items delivered to a person may not exceed the sum designated for the person's fiscal year maximum in the person's ICP.

(3) For each service specified in a person's ICP, the total sum expended for the service may not exceed the sum designated as available for that service in the person's ICP.

(4) An ICP is developed by the person's case manager. For services reimbursed on time units the case manager estimates the levels of service delivery based on a reasonable assessment of the direct care staff time necessary to meet the health and safety needs of the person. The case manager uses the standardized reimbursement rates and any specified rates of reimbursement for particular services and items to calculate the amount of monies necessary to fund the services and items to be provided to the person.

(5) Neither the Montana resource allocation tool nor the plan of care may be used to authorize reimbursement for services or items.

History: 53-2-201, 53-6-402, MCA; IMP, 53-2-201, 53-6-402, MCA; NEW, 2011 MAR p. 1718, Eff. 8/26/11; AMD, 2013 MAR p. 1212, Eff. 7/12/13.