REVISED DATE

001

CONTENTS INDEX

05/01/09

002

ALPHA INDEX

01/01/08

400

ELIGIBILITY FOR SERVICES

401

Medicaid Eligibility Requirements

02/01/06

402

Program Eligibility and Medical Need

12/01/01

403

General Provisions and Services

01/01/08

404

Service Limitations and Exclusions

02/01/06

405

Reserved

01/01/08

406

Reserved

02/01/06

407

Denial of Initial Services

09/11/00

408

Reserved

02/01/06

409

Private Pay

07/01/00

410

Reserved

02/01/06

411

New Admissions (Initial)

02/01/06

412

Request to Change Agencies

04/01/04

413

Switch in Options

01/01/08

414

High Risk Cases

01/01/08

415

Annual Mountain Pacific Quality Health Foundation Reviews

01/01/08

416

Shared Cases

07/01/01

417

Request to Amend Authorization

01/01/08

500

MOUNTAIN PACIFIC QUALITY HEALTH FOUNDATION

501

Prior Authorization Contract Requirements

04/01/04

502

New Admissions

01/01/08

503

Personal Assistance Services Consumer

   Overview/Referral (DPHHS-SLTC-154)

02/01/06

504

Personal Assistance Services Profile

  (DPHHS-SLTC-155)

02/01/06

505

Personal Assistance Services

   Authorization (DPHHS-SLTC-151)

04/01/04

506

Contract Performance Standards

04/01/04

600

ADMINISTRATIVE REQUIREMENTS

601

Provider Enrollment

02/01/06

602

Provider Responsibilities

02/01/06

603

Provider Training

02/01/06

604

Payment Requirements

02/01/06

605

Payment Processing

01/01/08

606

Reimbursement Methodology

01/01/08

607

Discontinuation

07/01/00

608

Records Retention

04/01/04

700

SERVICE REQUIREMENTS

701

Provider Intakes

01/01/08

702

Nurse Supervision

01/01/08

703

Supervisory Visits

01/01/08

704

Complaint Procedures

07/01/01

705

Termination of Services Discharges/Temporary Absences

02/01/06

706

Training

01/01/08

707

Mileage and Escort

01/01/08

708

Reporting of Serious Occurrences

01/01/08

709

Home and Community Based Services Program

02/01/06

710

Live-in Attendants, Family and Significant Others

02/01/03

711

Medicare Home Health Aides

01/01/08

712

Services to Individuals Under Age 21

01/01/08

713

Services to the Developmentally Disabled

02/01/06

714

Services to Pregnant Women

07/01/00

800

RULES AND RESOURCES

801

Provider Requirement Administrative Rules of Montana

02/01/06

802

Provider Sanction Administrative Rules of Montana

02/01/06

803

Personal Care Administrative Rules of Montana

02/01/06

804

Self-Directed Personal Assistance Services

   Administrative Rules of Montana

02/01/06

805

Elder Abuse Law

02/01/06

806

Provider Inquiry of Medicaid Eligibility

01/01/08

807

Release of Information Form

01/01/08

900

FORMS

901

General Information - Forms

   Forms Requisition

05/01/09

902

General Utilization

05/01/09

903

Form DPHHS-SLTC-161, Personal Assistance

   Services Temporary Authorization

01/01/08

904

Reserved

02/01/06

905

Form DPHHS-SLTC-150, Personal Assistance

   Services Nurse Supervision Documentation

02/01/06

906

Form DPHHS-SLTC-157, Change in Demographics

01/01/08

907

Form DPHHS-SLTC-158, Personal Assistance

   Services Agency Discharge/Unable to Admit Sheet

05/01/09

908

Personal Assistance Services

   Agency Intake Sheet

05/01/09

909

Reserved

05/01/09

910

Personal Assistance Serious Occurrence Report

   Serious Occurrence Report

05/01/09

911

Sample of Personal Assistance Services Delivery Record

01/01/08

912

Provider Prepared Standards

01/01/08

913

Form DPHHS-MA-128 Request for Case Review

02/01/06