Plain Text Law

Regulation .22 Conditions for Reimbursement.

Regulation .22 Conditions for Reimbursement.Copy Citation

The Program shall reimburse for the services specified in Regulations .14—.21 of this chapter, if provided in accordance with the requirements of this chapter and if the service:
A.
Is recommended on the participant’s plan of service as necessary in order to:
(1)
Prevent the applicant’s or participant’s admission to an institution;
(2)
Safely transition the applicant or participant from an institution, such as a nursing facility, into the community; or
(3)
Assure the health and safety of an applicant or participant in the community;
B.
Has been preauthorized by the Department in the participant’s plan of service;
C.
Is provided to an enrolled participant;
D.
Is medically necessary; and
E.
Is provided by a Medicaid provider who meets the conditions for participation under this chapter.