ARM 37.86.5204. CRITERIA FOR DETERMINING MEDICAID AND HEALTHY MONTANA KIDS PLUS (HMK PLUS) ELIGIBLE INDIVIDUALS MANAGED UNDER THE HEALTH IMPROVEMENT PROGRAM

(1) The department employs high risk case identification to assign those individuals who are potentially high risk or high cost to the Health Improvement Program. Selection criteria are subject to change as clinical practices and evidenced-based health care practice guidelines change. The following criteria are used: (a) individuals who have high medical costs; (b) individuals who are at risk for above-average future medical service utilization; and (c) individuals who are able to understand and apply recommended health management techniques.