(1) Services available through the program are reimbursed as specified in this rule.

(2) The following services are reimbursed as provided in (3) :

(a) environmental accessibility adaptations;

(b) homemaking;

(c) adult day health;

(d) habilitation;

(e) personal emergency response systems;

(f) nutrition;

(g) psycho-social consultation;

(h) nursing;

(i) respiratory therapy;

(j) dietetic services;

(k) specially trained attendant care;

(l) behavioral programming;

(m) chemical dependency counseling;

(n) cognitive rehabilitation;

(o) comprehensive day treatment;

(p) community residential rehabilitation;

(q) supported living;

(r) specialized child care for children with AIDS;

(s) adult residential care;

(t) respite care not provided by a nursing facility; and

(u) nonmedical transportation.

(3) The services specified in (2) are, except as otherwise provided in (4) , reimbursed at the lower of the following:

(a) the provider’s usual and customary charge for the service; or

(b) the rate negotiated with the provider by the case management team up to the department's maximum allowable fee.

(4) The services specified in (2) are reimbursed as provided in (3) except that reimbursement for components of those services that are incorporated by specific cross reference from the general medicaid program may only be reimbursed in accordance with the reimbursement methodology applicable to the component service as a service of the general medicaid program.

(5) The following services are reimbursed in accordance with the referenced provisions governing reimbursement of those services through the general medicaid program:

(a) personal assistance as provided at ARM 37.40.1105 and 37.40.1302;

(b) outpatient occupational therapy as provided at ARM 37.86.610;

(c) outpatient physical therapy as provided at ARM 37.86.610;

(d) speech therapy as provided at ARM 37.86.610; and

(e) audiology as provided at ARM 37.86.705.

(6) Case management services are reimbursed, as established by contractual terms, on either a per diem or hourly rate.

(7) Respite care services provided by a nursing facility are reimbursed at the rate established for the facility in accordance with ARM Title 37, chapter 40, subchapter 3.

(8) Specialized medical equipment and supplies are reimbursed as follows:

(a) equipment and supplies which are reimbursable under ARM 37.86.1801, 37.86.1802, 37.86.1806 and 37.86.1807 shall be reimbursed as provided in ARM 37.86.1807;

(b) equipment and supplies which are not reimbursable under ARM 37.86.1801, 37.86.1802, 37.86.1806 and 37.86.1807 shall be reimbursed at the lower of the following:

(i) 100% of the provider's usual and customary charge for the item; or

(ii) the rate negotiated with the provider by the case management team up to the department's maximum allowable fee.

(9) Reimbursement is not available for the provision of a service to a person that may be reimbursed through another program.

(10) No copayment is imposed on services provided through the program but recipients are responsible for copayment on other services reimbursed with medicaid monies.

(11) Reimbursement is not available for the provision of services to other members of a recipient's household or family unless specifically provided for in these rules.