37.86.4005    TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, SERVICE COVERAGE

(1) TCM services must meet all requirements found in ARM 37.86.3301 through 37.86.3306.

(2) TCM services for substance use disorders include those indicated in ARM 37.86.4001(2) through (5).

(3) TCM services for substance use disorders are provided by state-approved chemical dependency treatment programs in accordance with these rules and the provisions of ARM 37.27.901 through ARM 37.27.912, and 53-24-208, MCA.

(4) TCM services may include contacts with noneligible individuals for purposes related to identification of the person's needs, accessing needed services, identifying needs and supports to assist in obtaining identified services, providing case managers with useful feedback, and alerting case managers to changes in the person's needs.

(5) TCM does not include:

(a) direct delivery of medical, educational, social, or other services to which a person has been referred;

(b) when activities are an integral and inseparable component of another covered Medicaid service;

(c) duplicate payments made to public agencies or private entities under the State Plan and other program authorities;

(d) writing, recording, or entering case notes for the person's file;

(e) coordination of the investigation of suspected abuse, neglect, and/or exploitation cases;

(f) travel to and from activities, with or without the person;

(g) any service that does not incorporate the allowable TCM components, even if written into the individualized TCM case plan;

(h) Medicaid determination and redetermination (arranging for appointments, monitoring completion of needed steps for determination are eligible TCM services); and

(i) activities for which a person may be eligible that are integral to the administration of another nonmedical program such as guardianship, child welfare/child protective services, parole, probation, foster care services, or specialized education programs except for case management that is included in an individualized education program or individualized family service plan consistent with SSA section 1903c for services furnished to a child with a disability or to an infant or toddler with a disability.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-113, MCA; NEW, 2013 MAR p. 269, Eff. 3/1/13.