REVISED

001

CONTENTS INDEX

01/01/08

002

ALPHA INDEX

01/01/08

400

ELIGIBILITY FOR SERVICES

401

Medicaid Eligibility Requirements

02/01/06

402

Program Eligibility and Medical Need

01/01/02

403

General Provisions and Services

02/01/06

404

Service Limitations and Exclusions

02/01/06

405

Consumer Identification

01/01/08

406

Reserved

02/01/06

407

Denial of Initial Services

01/01/01

408

Reserved

02/01/06

409

Private Pay

02/01/06

410

Reserved

02/01/06

411

New Admissions

01/01/08

412

Request to Change Agencies

02/01/06

413

Switch in Options

01/01/08

414

High Risk Cases

01/01/08

415

Annual Mountain Pacific Health Foundation Reviews

01/01/08

416

Shared Cases

07/01/01

417

Request to Amend Authorization

01/01/08

418

Health Care Professional Authorization

02/01/06

419

Change in Personal Representative

01/01/08

500

MOUNTAIN PACIFIC QUALITY HEALTH FOUNDATION

501

Prior Authorization Contract Requirements

08/01/02

502

New Admissions

01/01/08

503

Personal Assistance Services Consumer

Form/Referral (DPHHS-SLTC-154)

01/01/08

504

Personal Assistance Services Profile

(DPHHS-SLTC-155)

01/01/08

505

Self-Directed Personal Assistance Services

Authorization Form (DPHHS-SLTC-152)

04/01/04

506

Contract Performance Standards

01/01/02

600

ADMINISTRATIVE REQUIREMENTS

601

Consumer/Personal Representative Responsibility

01/01/08

602

Provider Eligibility/Responsibilities

02/01/06

603

Provider Enrollment

02/01/06

604

Payment Requirements

02/01/06

605

Payment Processing

01/01/08

606

Reimbursement Methodology

01/01/08

607

Provider Disenrollment/Reduction in Service Area

07/01/00

608

Records Retention

04/01/04

609

Dually Enrolled Providers

07/01/00

700

SERVICE REQUIREMENTS

701

Consumer Capacity

02/01/06

702

Program Oversight

01/01/08

703

Recertification

02/01/06

704

Complaint Procedures

01/01/01

705

Termination of Services/Discharges/Temporary Absences

02/01/06

706

Training

01/01/08

707

Mileage for Escort and Shopping

01/01/08

708

Reporting of Serious Occurrences

01/01/08

709

Home and Community Based Services Program

01/01/08

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

04/01/04

714

Services to Pregnant Women

07/01/00

715

Personal Representative

01/01/08

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-165, Self-Directed Personal Assistance Services

Temporary Authorization

02/01/06

904

Form DPHHS-SLTC-167, Self-Directed Personal Assistance

02/01/06

Services Program Compliance Tool

02/01/06

905

Form DPHHS-SLTC-164, Self-Directed Personal Assistance

Services Oversight Documentation

01/01/08

906

Form DPHHS-SLTC-157, Personal Assistance

Services Change in Demographics

01/01/08

907

Form DPHHS-SLTC-158, Personal Assistance

Services Agency Discharge/Unable to Admit Sheet

05/01/09

908

Self-Directed Personal Assistance Services

Agency Admit 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

Form DPHHS-SLTC-160, Self-Directed Personal Assistance

Services Health Care Professional Authorization

01/01/08

913

Form DPHHS-SLTC-159, Self-Directed Personal Assistance

Services Consumer Agreement

01/01/08

914

Form DPHHS-SLTC-166, Self-Directed Personal Assistance

Services Personal Representative Agreement

01/01/08

915

Self-Directed Personal Assistance Services

Provider Prepared Standards

01/01/08

916

Form DPHHS-MA-128, Request for Case Review

02/01/06