ARM 37.86.5205. DISEASE MANAGEMENT PROGRAM: CLIENT ELIGIBILITY AND ASSIGNMENT

(1) To receive disease management services an eligible client must be a recipient of Montana medicaid and be diagnosed with at least one of the following chronic medical conditions: (a) asthma; (b) diabetes; (c) heart failure; (d) chronic pain; or (e) cancer. (2) A client must not be: (a) receiving mental health service plan (MHSP) benefits, specified low income medicare beneficiary (SLMB) benefits or qualified medicare beneficiary (QMB) benefits; (b) residing in a nursing home or institutional setting for more than 30 days; (c) receiving medicaid benefits through presumptive eligibility; (d) eligible for third party coverage that provides disease management program services or requires administrative controls that would duplicate or interfere with Montana medicaid's disease management program; or (e) receiving case management services that disease management program services would duplicate. (3) A client meeting the eligibility requirements in this rule: (a) is automatically enrolled in the disease management program; (b) is notified of the enrollment in writing; (c) may request a disenrollment at any time; and (d) may request a re-enrollment at any time.