1. (1) Pediatric Complex Care Assistant (PCCA) service provider agencies must be enrolled Medicaid providers.
2. (2) PCCA service provider agencies must be a business entity formed or registered to do business under Montana law.
3. (3) PCCA services must be prior-authorized by the department or the department's designee.
4. (4) PCCA service provider agencies must provide documentation to the department verifying the PCCA’s certification training and current licensure.

5. (5) PCCA service provider agencies must use an electronic visit verification (EVV) system to electronically document the delivery of services and submit claims.

   1. (a) In accordance with 42 U.S.C. 1396b(l), the EVV system must capture the following data elements:

      1. (i) the type of service performed;
      2. (ii) the member receiving the service;
      3. (iii) the date of the service;
      4. (iv) the location of the service delivery;
      5. (v) the individual providing the service; and
      6. (vi) the time the service begins and ends.
   2. (b) The use of EVV is required for all members utilizing PCCA services, including members for whom services are provided by a live-in caregiver.

Authorizing statute(s): 53-6-101, 53-6-113, MCA

Implementing statute(s): 53-6-101, 53-6-113, MCA

History: NEW, 2025 MAR, Notice No. 2025-53, Eff. 9/27/25.