Rule 37.40.1407 - HOME AND COMMUNITY-BASED SERVICES FOR ELDERLY AND PHYSICALLY DISABLED PERSONS: GENERAL REQUIREMENTS(1) Services of the program may only be provided by a provider that is enrolled with the department as a Medicaid provider or, in rare instances, through a provider with whom the department is contracting for home and community-based case management services.(2) A facility providing services to a recipient must meet all licensing requirements including fire and safety standards as well as other service-specific requirements set forth by the department in this chapter.(3) A provider of services must ensure that the services adhere to the requirements of 42 CFR 441.301(c)(4), which permits reimbursement with Medicaid monies only for services within settings that meet certain qualities set forth under the regulation. These qualities include that the setting: (a) is integrated in and facilitates full access of the individual to the greater community;(b) ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid Home and Community-Based Services;(c) is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting;(d) ensures the individual's rights of privacy, dignity, and respect, and freedom from coercion and restraint;(e) supports health and safety based upon the individual's needs, decisions, or desires;(f) optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including, but not limited to daily activities, physical environment, and with whom to interact;(g) provides an opportunity to seek employment and work in competitive integrated settings; and(h) facilitates individual choice of services and supports, and who provides them.(4) A provider of services must meet the requirements necessary for the receipt of reimbursement with Medicaid monies.(5) Immediate family members and legally responsible individuals may be paid for the provision of certain services under the following conditions: (a) the service is identified in the federally approved waiver;(b) the service is specified in the individual's service plan;(c) the family member or legally responsible individual meets the provider qualifications and training standards for that service as specified in the federally approved waiver;(d) the services do not supplant tasks that are customarily performed by legally responsible individuals; and(e) the family member or legally responsible individual may not provide more than 40 hours of service in a seven-day period.(6) Immediate family members include:(b) a natural or adoptive parent of a minor child.(7) A provider may also provide support to other family members in the recipient's household during hours of program reimbursed service if approved by the case management team or FM.(8) The department adopts and incorporates by reference 42 CFR 441.301(c)(4), as amended January 16, 2014. A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Services, Senior & Long-Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210.Mont. Admin. r. 37.40.1407
NEW, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1986 MAR p. 2094, Eff. 1/1/87; AMD, 1988 MAR p. 1268, Eff. 7/1/88; AMD, 1991 MAR p. 470, Eff. 12/14/90; TRANS & AMD, from SRS, 2000 MAR p. 2023, Eff. 7/28/00; AMD, 2011 MAR p. 1722, Eff. 8/26/11; AMD, 2024 MAR p. 612, Eff. 3/23/2024AUTH: 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA; IMP: 53-2-201, 53-6-101, 53-6-402, MCA