The following terms and definitions apply to the disease management program:

(1) "Disease management organization (DMO)" means a clinically qualified organization that has a disease management program which uses evidence based health care practices.

(2) "Disease management program services" means specialized services provided to Medicaid clients meeting the eligibility criteria listed in ARM 37.86.5205. Disease management program services are aimed at care coordination, client education, improved client self-care, and efficiency, and cost effectiveness of services.

(3) "Eligible client" means a Montana Medicaid client who has the disease management program's specified combination of eligibility and disease factors.

(4) "Enrolled client" means an eligible client who has been notified in writing of enrollment in the disease management program and eligibility to receive disease management program services and who has not declined to participate.

(5) "Evidence based healthcare practice" means a clinical approach to practicing medicine based on the clinician's awareness of medical evidence and the strength of that evidence to support the management of a disease treatment process.

(6) "Medical home" means one provider or clinic who provides the majority of all ambulatory health care services to each client. This provider is the client's source for routine or preventive healthcare.