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(1) The services available through the program are limited to those specified in this rule.

(2) The department may determine the particular services of the program to make available to a recipient based on, but not limited to, the following criteria:

(a) the recipient's need for a service generally and specifically;

(b) the availability of a specific service through the program and any ancillary service necessary to meet the recipient's needs;

(c) the availability otherwise of alternative public and private resources and services to meet the recipient's need for the service;

(d) the recipient's risk of significant harm or of death if not in receipt of the service;

(e) the likelihood of placement into a more restrictive setting if not in receipt of the service; or

(f) the financial costs for and other impacts on the program arising out of the delivery of the service to the person.

(3) A person enrolled in the program may be denied a particular service available through the program that the person desires to receive or is currently receiving.

(4) Bases for denying a service to a person include, but are not limited to:

(a) the person requires more supervision than the service can provide;

(b) the person's needs, inclusive of health, can no longer be effectively or appropriately met by the service;

(c) access to the service, even with reasonable accommodation, is precluded by the person's health or other circumstances;

(d) a necessary ancillary service is no longer available; and

(e) the financial costs for and other impacts on the program arising out of the delivery of the service to the person.

(5) The department may make program services for persons with intensive needs available to a recipient whom it determines, based on past medical history and current medical diagnosis, would otherwise require on a long-term basis the level of care of an inpatient hospital or a rehabilitation service setting.

(6) The following services, as defined in these rules, may be provided through the program:

(a) adult day health;

(b) adult residential care;

(c) case management services;

(d) community supports services;

(e) community transition services;

(f) consultative clinical and therapeutic services;

(g) consumer-directed goods and services;

(h) day habilitation;

(i) dietetic services;

(j) environmental accessibility adaptations;

(k) family training and support;

(l) financial management;

(m) habilitation;

(n) health and wellness;

(o) homemaker chore services;

(p) homemaker;

(q) independence advisor;

(r) nonmedical transportation;

(s) nursing;

(t) nutrition services;

(u) occupational therapy;

(v) pain and symptom management;

(w) personal assistance;

(x) personal emergency response systems;

(y) physical therapy;

(z) post-acute rehabilitation services;

(aa) respiratory therapy;

(bb) respite care;

(cc) senior companion services;

(dd) speech pathology and audiology;

(ee) specially trained attendants;

(ff) specialized child care for medically fragile children;

(gg) specialized medical equipment and supplies;

(hh) supported living; and

(ii) vehicle modifications.

(7) Monies available through the program may not be expended on the following:

(a) room and board;

(b) special education and related services as defined at 20 USC 1401(16) and (17); and

(c) vocational rehabilitation.

(8) The program is considered the payor of last resort. A service available through the program is not available to any extent that a service of another program is otherwise available to a recipient to meet the recipient's need for that service.

History: 53-2-201, 53-6-101, 53-6-113, 53-6-402, MCA; IMP, 53-2-201, 53-6-101, 53-6-402, MCA; 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.

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