Rule 37.86.3402 - TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, ELIGIBILITY(1) A member is eligible for targeted case management as a high risk pregnant woman if: (a) the person is receiving Medicaid or is presumptively eligible for Medicaid; and(b) the member's pregnancy outcome is considered high risk.(2) A pregnancy is of high risk if the member:(a) is age 17 or younger;(b) has medical factors which indicate the potential for a poor pregnancy outcome;(c) abuses alcohol, tobacco, or drugs;(d) has someone in the member's immediate environment who abuses alcohol, tobacco, or drugs;(e) is currently in an abusive relationship;(g) has had greater than three residences during pregnancy; or(h) demonstrates an inability to obtain necessary resources and services and the member meets three of the following criteria: (i) has a history of physical or sexual abuse;(ii) has no support system or involvement of a spouse or other supporting person;(iii) has not had a dental cleaning in the last year;(iv) is not educated beyond the 12th grade level or does not have a GED;(v) has a physical disability or mental impairment;(vi) has had no prenatal care before or during the first 20 weeks of gestation;(vii) is a refugee or a migrant worker;(ix) is over the age of 35; or(x) has limited English proficiency.(3) The member is not eligible for targeted case management services if enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program (HIP).(4) Targeted case management services may be delivered to the member, if Medicaid eligibility continues, until the last day of the month in which the 12-month postpartum period following delivery ends.Mont. Admin. r. 37.86.3402
NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/2017; AMD, 2024 MAR p. 2021, Eff. 8/10/2024AUTH: 53-6-113, MCA; IMP: 53-6-101, MCA