37.34.946    0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: INDIVIDUAL GOODS AND SERVICES

(1) Individual goods and services are services, supports, or goods that enhance opportunities to achieve outcomes related to living arrangements, relationships, and inclusion in the community as identified and documented in the plan of care.

(2) Individual goods and services must fall into one of the following categories:

(a) memberships and fees; or

(b) equipment and supplies.

(3) Individual goods and services must be:

(a) exclusively for the benefit of the person; and

(b) the most cost-effective alternative that reasonably meets the assessed need of the person.

(4) The service, equipment, or supply must meet the person's medical needs or provide support in order to be independent in daily activities and must meet one of the following criteria:

(a) promotes inclusion in the community;

(b) increases the person's safety in the home environment; or

(c) decreases the need for other Medicaid services.

(5) The cost of the service, equipment, or supply must not compromise the person's health or safety by depleting their individual cost plan to the extent they cannot receive services that provide for their health and safety.

(6) Service, equipment, or supplies which are experimental will not be reimbursed.

(7) A person or the person's delegate self-directing services with employer authority using the financial management service (FMS) option must purchase goods and services in accordance with the requirements set forth by the Developmental Disabilities Program (DDP) and receive reimbursement from the fiscal management service.

(8) Individual goods and services expected to exceed a $2,000 annual aggregate limit require prior approval by the DDP regional manager.

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; TRANS, from SRS, 1998 MAR p. 3124; AMD, 2014 MAR p. 220, Eff. 1/31/14.