Sec. 10.09.84.22. Conditions for Reimbursement

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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 participants plan of service as necessary in order to:

(1) Prevent the applicants or participants 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 participants 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.

                    
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