24.29.2851 LIMITATION ON EXPENDITURES FOR MEDICAL BENEFITS PAYABLE BY THE UEF -- APPLICABILITY
(1) Pursuant to 39-71-503 and 39-71-510 , MCA, the maximum aggregate expenditure for medical benefits per claim payable by the UEF is $100,000. The $100,000 limitation is based on the amount actually paid by the UEF, after applying the fee schedules adopted pursuant to 39-71-704 and 39-71-727 , MCA, to the medical services.
(2) The limitation applies to primary medical services and to those secondary medical services approved by the UEF.
(3) To the extent practicable, the UEF will reimburse providers for services provided at the earliest date or time before reimbursing for services provided at a later date or time. In the event of a catastrophic injury, however, it may not be feasible to identify the exact timing of the provision of services, and multiple providers may be simultaneously rendering services to the injured worker. The UEF reserves the right to make reasonable judgments regarding which services will be reimbursed first.
(4) The term "medical benefits", as used in this rule, includes:
(a) provider fees, whether for charges for direct services or for facility-related fees;
(b) prescription medications;
(c) allowed medical supplies; and
(d) durable medical equipment.
(5) This rule applies to claims arising on or after July 1, 2007.
History: 39-71-203, MCA; IMP, 39-71-503, 39-71-510, 39-71-704, 39-71-727, MCA; NEW, 2007 MAR p. 1446, Eff. 9/21/07.