(1) If a disease management program is provided by a DMO, the program must meet the following criteria:

(a) the program requirements stated in the contract between the department and the DMO must be fulfilled;

(b) the scope of practice must be appropriate for the provider of the health care service; and

(c) the DMO must comply with all other applicable state and federal requirements.

(2) Only a DMO contracted with the department may bill and be reimbursed for providing disease management services. Billing requirements and payment methodology will be described in a contract between the DMO and the department.