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This is an obsolete version of the rule. Please click on the rule number to view the current version.

37.86.5202    HEALTH IMPROVEMENT PROGRAM: GENERAL

(1) The Health Improvement Program provides coordinated health care interventions and education for Medicaid and HMK Plus clients. The purpose of the program is to provide and/or coordinate services that decrease utilization and cost while optimizing treatment and improving health outcomes for clients.

(2) Health improvement program services must include one or more of the following to each identified high risk client:

(a) assistance in establishing a medical home;

(b) educational materials;

(c) instruction regarding self-managing conditions;

(d) assessment of available services, equipment, and supplies that might enhance the client's ability to manage the client's disease processes; or

(e) coordination with other authorized case managers.

(3) Health improvement program services do not:

(a) change the scope of services available to a client eligible under a Title XIX Medicaid program;

(b) interfere with the relationship between an enrolled client and the client's chosen provider(s);

(c) duplicate case management activities available to a client in the client's community; or

(d) substitute for established activities that are available to a client and provided by programs administered through other department divisions or state agencies.

 

History: 53-6-101, 53-6-113, MCA; IMP, 53-6-101, 53-6-113, MCA; NEW, 2003 MAR p. 2892, Eff. 12/25/03; AMD, 2007 MAR p. 978, Eff. 7/6/07; AMD, 2010 MAR p. 1544, Eff. 6/25/10.

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