53-6-405 Fraud prevention education -- department responsibilities

53-6-405 . Fraud prevention education -- department responsibilities. (1) In an effort to prevent and reduce fraud in the Montana medicaid program, a provider of personal assistance or attendant services or supports shall provide training and continuing education to consumers and employees if the personal assistance or attendant services or supports are funded:

(a) as a medicaid state plan service;

(b) through a medicaid state plan option available to the state under 42 U.S.C. 1396n(k); or

(c) under a medicaid home and community-based services waiver for the elderly and disabled that is operated through a division of the department that administers long-term care services for senior citizens and individuals with physical disabilities.

(2) (a) The training must be presented in person whenever the provider:

(i) hires a new employee; or

(ii) enrolls a consumer to receive services.

(b) The provider shall require its employees and the consumers who are receiving services to review fraud prevention materials on an annual basis after completing the initial training.

(c) Each employee and consumer shall sign a document attesting to the fact that the employee or consumer received the in-person training or received and reviewed the fraud prevention materials.

(d) When the training involves services provided using a self-directed service model, the consumer may provide the training.

(3) The training and continuing education must include but are not limited to information on:

(a) activities that constitute fraud;

(b) ways to prevent fraud; and

(c) when and how to report fraud, including how to contact the medicaid fraud hotline.

(4) (a) The department and the medicaid fraud control unit provided for in 53-6-156 shall, in consultation with home and community-based services consumers, providers, and advocates, develop the elements to be included in the training.

(b) A provider required to provide training under this section may:

(i) develop training materials that meet the requirements developed by the department and the medicaid fraud control unit; or

(ii) use training materials approved by the department by rule.

(5) The department may adopt rules requiring other providers of medicaid home and community-based services that are provided in a person's home to provide the training required under this section.

(6) The department shall:

(a) review and approve fraud education materials; and

(b) monitor compliance with training requirements.