37.86.5111    PASSPORT TO HEALTH PROGRAM: PRIMARY CARE PROVIDERS REQUIREMENTS

(1) A primary care provider must meet the following requirements:

(a) enroll as a Medicaid provider;

(b) provide primary care;

(c) sign a Passport agreement for primary care case management; and

(d) keep a paper or electronic log, spreadsheet, or other record of all Passport referrals given and received.

(2) A primary care provider may be subject to utilization review to determine that the care and services provided through the program are fulfilling the provisions of the primary care case management agreements with the program and are only those which are medically necessary or otherwise permissible.

(3) Passport providers who reach their specified caseloads of Passport patients, per their provider agreements with the department, will not be assigned additional members. Providers who have reached their capacity will be provided the opportunity to increase their caseloads. Providers that are not provider-based as described at ARM 37.86.3031 may request an exemption from this rule.

History: 53-2-201, 53-6-113, MCA; IMP, 53-6-116, MCA; NEW, 1992 MAR p. 2288, Eff. 10/16/92; AMD, 1994 MAR p. 313, Eff. 2/11/94; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 866, Eff. 3/31/00; AMD, 2013 MAR p. 1447, Eff. 8/9/13; AMD, 2014 MAR p. 125, Eff. 1/17/14.