Mont. Admin. r. 37.86.202

Current through Register Vol. 23, December 6, 2024

Rule 37.86.202 - MID-LEVEL PRACTITIONER SERVICES, DEFINITIONS

For the purpose of these rules, the following definitions will apply:

(1) "Advanced practice registered nurse" means a registered professional nurse licensed as provided in Title 37, chapter 8, MCA and ARM Title 24, chapter 159, subchapter 14 and includes nurse practitioner, nurse anesthetist, and nurse midwife and clinical nurse specialist.

(2) "Clinical nurse specialist" means a person who is licensed in accord with 37-8-405 through 37-8-407, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1485.

(3) "Delivery services" means services necessary to protect the health and safety of the woman and fetus from the onset of labor through delivery.

(4) "Early elective delivery" means either a nonmedically necessary labor induction or cesarean section that is performed prior to 39 weeks and 0/7 days gestation.

(5) "Independent employment status" means that a separate federal tax identification number is obtained for the mid-level practitioner and the billed services are not provided in the course of the mid-level practitioner's employment by or contract with a physician, hospital, or ambulatory surgical center.

(6) "Mid-level practitioner" means the following professionals:

(a) advanced practice registered nurse; and

(b) physician assistant.

(7) "Mid-level practitioner services" means those services provided by mid-level practitioners in accord with the laws and rules defining and governing through licensing and certification the practices of advanced practice registered nurses and physician assistants.

(8) "Nurse anesthetist" means a person who is licensed in accord with 37-8-405 through 37-8-407, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1480.

(9) "Nurse midwife" means a person who is licensed in accord with 37-8-405 through 37-8-407, 37-8-409, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1475.

(10) "Nurse practitioner" means a person who is licensed in accord with 37-8-405 through 37-8-407, MCA and ARM 24.159.1412, 24.159.1413, 24.159.1414, and 24.159.1470.

(11) "Physician assistant" means a person who is licensed as provided in Title 37, chapter 20, MCA and ARM Title 24, chapter 159, subchapter 14.

(12) "Postpartum services" means services rendered to a woman during the 12-month postpartum period after pregnancy ends for any health conditions or complications that are pregnancy-related.

(13) "Pregnancy-related services" means services for the treatment of conditions or complications that exist or are exacerbated because of pregnancy.

(14) "Prenatal services" means services directed at protecting and insuring the health of the woman and the fetus during pregnancy.

(15) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted at ARM 37.86.101 set forth meanings of terms commonly used by the Montana Medicaid program in implementation of the program's mid-level practitioner fee schedule.

(16) The "Physician-Related Services Manual" means the physician-related services manual adopted at ARM 37.86.101. It governs the administration of the mid-level practitioner program.

Mont. Admin. r. 37.86.202

NEW, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1991 MAR p. 1044, Eff. 6/28/91; AMD, 1994 MAR p. 313, Eff. 2/11/94; AMD, 1995 MAR p. 1580, Eff. 8/11/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2012 MAR p. 2625, Eff. 1/1/13; AMD, 2014 MAR p. 2171, Eff. 10/1/14; AMD, 2015 MAR p. 145, Eff. 2/13/2015; AMD, 2024 MAR p. 2021, Eff. 8/10/2024

AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-6-101, MCA