Payment will not be made to a case manager for the following:

1. (1) Targeted case management services that are available through other public agencies, private insurance plans and State or Federal programs.
2. (2) Targeted case management services provided to recipients who reside in a geographic area excluded from the program for that target group or who do not otherwise qualify as members of a target group.
3. (3) Targeted case management that is provided as an integral part of another covered MA service.
4. (4) Services provided for purposes other than to assist the recipient to gain access to medical and social services related to a targeted illness. These services include institutional discharge planning and outreach activities for the purpose of seeking potential recipients of targeted case management services.
5. (5) Services other than those defined by the Department as targeted case management services.
6. (6) Direct patient care services other than those provided for under this chapter.