37.34.907    0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: SELECTION AND ENTRY

(1) A person may be placed on the statewide waiting list for consideration for selection and entry into the 0208 Medicaid Home and Community-Based (HCBS) Waiver Program if the person is found eligible for the Developmental Disabilities Program (DDP) service in accordance with ARM 37.34.906.

(2) The DDP will enter the person's name onto the waiting list in chronological order based upon the date the case manager receives a complete request for services.

(3) The selection for consideration of persons with the same waiting list date will be made through a random selection process by the department.

(4) The DDP designee must notify a person selected for entry into the 0208 HCBS Waiver Program and the person's case manager in writing within ten working days of selection.

(5) Within five working days from the date of the notification letter, the department designee must present all waiver service options available to the person selected, document which providers the person requests to meet, and submit to the providers:

(a) the provider service referral packet;

(b) the plan of care; and

(c) other documents, as requested.

(6) A provider must contact the department designee within ten working days from the date the provider service referral packet was submitted to the provider and either:

(a) offer to serve the person; or

(b) decline to offer services.

(7) The person must determine which provider(s) he or she will accept services from within five days following the offer(s).

(8) The case manager must:

(a) document the person's choice of provider(s);

(b) obtain the person's or the person's legal representative's signature; and (c) maintain the documentation in the person's file.

(9) Upon acceptance of service(s), the person must begin service(s) within 45 working days from the date of the provider(s) offer to serve the person.

(10) The department may prioritize and select a person who has a life-threatening physical condition, is eligible for DDP services, and whose continued existence would be jeopardized without services.

(11) The department reserves the right to select a person from the waiting list based upon emergency criteria if all other service options have been reviewed and do not meet the person's health and safety needs. The emergency criteria are as follows:

(a) a finding of maltreatment is determined by Child Protective Services or Adult Protective Services;

(b) the death of the person's primary caregiver, or the inability of that caregiver to provide care, and no alternative caregiver is available;

(c) lack of appropriate placement for the person due to loss of housing or imminent discharge from the temporary placement or hospitalization; or

(d) non-waiver services are insufficient to meet the severe and persistent clinical and treatment needs of the person due to a crisis or emergency situation that is currently threatening the person's life or safety. In the absence of a waiver slot, the person is at risk of an out of home placement, such as an institution or higher level of care.

(12) A person who is selected for entry into the 0208 HCBS Waiver Program and does not accept waiver services will be removed from the waiting list.

(13) If the person selected for entry into the 0208 HCBS Waiver Program cannot find a provider able or willing to provide services within 90 days from the date of the selection notification letter, the opening is forfeited.

(14) A person discharged from an ICF/IID located in the state of Montana who is eligible for home and community-based services in accordance with ARM 37.34.906 is not subject to the selection criteria and entry procedures otherwise stated in this rule. The department in its discretion may provide the person with a placement in the 0208 HCBS Waiver Program.

 

History: 53-6-113, 53-6-402, MCA; IMP, 53-6-101, 53-6-402, MCA; NEW, 1992 MAR p. 1490, Eff. 7/17/92; AMD, 1995 MAR p. 1136, Eff. 6/30/95; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14; AMD, 2023 MAR p. 1624, Eff. 11/18/23.