37.90.410 HOME AND COMMUNITY-BASED SERVICES FOR ADULTS WITH SEVERE AND DISABLING MENTAL ILLNESS: ELIGIBILITY AND SELECTION
(1) A member is eligible for enrollment in the program if the member meets the following criteria:
(a) is at least 18 years of age;
(b) is Medicaid eligible;
(c) requires the level of care (LOC) of a nursing facility as determined by the Quality Improvement Organization under contract with the department;
(d) meets the severe and disabling mental illness criteria at ARM 37.90.409; and
(e) meets the level of impairment criteria established in the waiver program Evaluation and Level of Impairment (LOI) form, as determined by a licensed mental health professional, by scoring a three or higher on at least two areas.
(2) Once a member is found eligible to receive waiver program services, the member is referred to the appropriate case management team. The case management team:
(a) offers the member an available opening for program services if one is available; or
(b) places the member on the wait list for an available opening.
(3) A member is placed on the wait list in the service areas the member selects.
(4) The case management team must use the member's combined LOC and LOI score to determine the member's score for placement on the wait list.
(5) If more than one member has the same combined wait list score, then each member is placed on the wait list based upon the member's wait list score as determined in (4), and thereafter on a first-come, first-served basis.
(6) A member may be removed from the SDMI HCBS waiver program for the following reasons:
(a) a determination by a mental health professional that the member no longer meets the eligibility criteria;
(b) the member does not select and actively participate in at least two services in the waiver program within 45 calendar days from the date the member agrees to and signs the PCRP;
(c) the department determines that the member has failed to utilize or attempted to utilize at least two waiver services, in over 90 days, with repeated attempts documented by the case management team to engage the member; and
(d) the member no longer requires the level of care of a nursing facility as determined by the Quality Improvement Organization under contract with the department.
(7) Eligibility for consideration for the waiver program does not entitle an individual for selection and entry into the program.
History: 53-2-201, 53-6-402, MCA; IMP, 53-6-402, MCA; NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2010 MAR p. 1538, Eff. 6/25/10; AMD, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2020 MAR p. 1173, Eff. 7/1/20.