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The definitions of targeted case management services for high risk pregnant women are as follows:

(1) "Care plan" means a specific written plan that is based on the information collected through the comprehensive assessment and periodic reassessment that:

(a) specifies the goals and actions to address the medical, social, educational, and other services needed by the member;

(b) includes activities such as ensuring the active participation of the member, and working with the member and others to develop those goals; and

(c) identifies a course of action to respond to the assessed needs of the member.

(2) "Comprehensive Assessment and Periodic Reassessment" means an evaluation to identify a member's need for any medical, educational, social, or other services. These assessment activities include:

(a) taking a member's history;

(b) identifying the member's needs and completing the related documentation; and

(c) gathering information from other sources to form a complete assessment of the member.

(3) "Monitoring and follow-up activity" means activities and contacts that are necessary to ensure the care plan is implemented and adequately addresses the member's needs. The activities may be with the member, family members, service providers, or other entities or individuals and may be conducted as frequently as necessary. Monitoring may be furnished through face-to-face visits, telephone calls, and telemedicine services.

(4) "Paraprofessional" means a person to whom a particular aspect of a professional task is delegated but who is not licensed to practice as a fully qualified professional.

(5) "Referral" means activities that help link the member with medical, social, or educational providers, and other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

(6) "Targeted case management" means services that assist a member to access needed medical, social, or other resources and services by establishing and maintaining a referral process for needed and appropriate services and avoiding duplication of services.


History: 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 1991 MAR p. 1295, Eff. 7/26/91; AMD, 1997 MAR p. 496, Eff. 3/11/97; TRANS, from SRS, 2000 MAR p. 481; AMD, 2017 MAR p. 1906, Eff. 10/14/17.

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