(1) To receive disease management services an eligible client must be a recipient of Montana medicaid and be diagnosed with at least one of the following chronic medical conditions:

(a) asthma;

(b) diabetes;

(c) heart failure;

(d) chronic pain; or

(e) cancer.

(2) A client must not be:

(a) receiving mental health service plan (MHSP) benefits, specified low income medicare beneficiary (SLMB) benefits or qualified medicare beneficiary (QMB) benefits;

(b) residing in a nursing home or institutional setting for more than 30 days;

(c) receiving medicaid benefits through presumptive eligibility;

(d) eligible for third party coverage that provides disease management program services or requires administrative controls that would duplicate or interfere with Montana medicaid's disease management program; or

(e) receiving case management services that disease management program services would duplicate.

(3) A client meeting the eligibility requirements in this rule:

(a) is automatically enrolled in the disease management program;

(b) is notified of the enrollment in writing;

(c) may request a disenrollment at any time; and

(d) may request a re-enrollment at any time.