Montana Administrative Code

37.87.1215 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, ASSESSMENT SERVICES Psychiatric residential treatment facility (PRTF) assessment services are provided by in-state PRTF facilities and must comply with the requirements of this subchapter and the applicable federal r…

37.87.1216 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, BENEFIT LIMITS, CERTIFICATION OF NEED, UTILIZATION REVIEW AND INSPECTIONS OF CARE REQUIREMENTS Prior to admission and as frequently as the department deems necessary, the department or its agents may evaluate the med…

37.87.1217 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, TREATMENT REQUIREMENTS PRTF services must include active treatment designed to achieve the discharge of the youth to a less restrictive level of care at the earliest possible time. PRTF services must be provid…

37.87.1222 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, INTERIM RATE AND COST SETTLEMENT PROCESS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA History: NEW, 2008 MAR p. 2674, Eff. 1/1/09; AMD, …

37.87.1223 IN-STATE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, REIMBURSEMENT The Montana Medicaid Program will reimburse providers of inpatient psychiatric services provided to a youth in a psychiatric residential treatment facility (PRTF) for each patient day, w…

37.87.1224 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, CONTINUITY OF CARE PAYMENT Hospital-based psychiatric residential treatment facilities as defined in ARM 37.87.1207 qualify for a continuity of care payment. The amount of the continuity of care adjustor payme…

37.87.1225 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, ADMINISTRATIVE REVIEW AND FAIR HEARING PROCEDURES The right to administrative review and fair hearing shall be in accordance with the provisions of ARM 37.5.310. Authorizing statute(s): 53-2-201, 53-6-113, MCA Implem…

37.87.1226 OUT-OF-STATE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, REIMBURSEMENT The Montana Medicaid Program will reimburse a provider of inpatient psychiatric services provided to a youth in a psychiatric residential treatment facility (PRTF) for each patient day, in …

37.87.1303 HOME AND COMMUNITY-BASED 1915(c) SERVICES BRIDGE WAIVER FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: FEDERAL AUTHORIZATION AND AUTHORITY OF STATE TO ADMINISTER PROGRAM (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-4…

37.87.1305 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: ELIGIBILITY FOR PROGRAM (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MA…

37.87.1306 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: SELECTION FOR PLACEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MA…

37.87.1307 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: LOSS OF A SERVICE AND DISENROLLMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; …

37.87.1313 1915(i) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN PROGRAM FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: FEDERAL AUTHORIZATION AND AUTHORITY OF STATE TO ADMINISTER PROGRAM (REPEALED) Authorizing statute(s): 53-6-113, MCA Implementing statute(s): 53-6-101, MCA …

37.87.1314 1915(i) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN PROGRAM FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-6-113, MCA Implementing statute(s): 53-6-101, MCA History: NEW, 2013 MAR p. 128, Eff. 2/1/13; AMD, 2013…

37.87.1315 1915(i) HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN PROGRAM FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: NOTICE AND FAIR HEARING (REPEALED) Authorizing statute(s): 53-6-113, MCA Implementing statute(s): 53-6-101, MCA History: NEW, 2013 MAR p. 128, Eff. 2/1/13;…

37.87.1321 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: THE PROVISION OF SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 …

37.87.1323 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE AND PLANS OF CARE: PLAN MANAGEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AM…

37.87.1325 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: COST OF PLAN OF CARE (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR p…

37.87.1331 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: PROVIDER REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR …

37.87.1333 HOME AND COMMUNITY-BASED 1915(c) SERVICES BRIDGE WAIVER FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; …

37.87.1335 HOME AND COMMUNITY-BASED 1915(c) SERVICES BRIDGE WAIVER FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: NOTICE AND FAIR HEARING (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff.…

37.87.1338 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: CONSULTATIVE CLINICAL AND THERAPEUTIC SERVICES, REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 M…

37.87.1339 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: CUSTOMIZED GOODS AND SERVICES, REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2…

37.87.1340 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: EDUCATION AND SUPPORT SERVICES, REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. …

37.87.1341 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: HOME-BASED THERAPY SERVICES, REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/1…

37.87.1342 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: NONMEDICAL TRANSPORTATION SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; A…

37.87.1343 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: RESPITE CARE SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2008 MAR p. 335, Eff. 2/15/08; AMD, 2009 MAR …

37.87.1344 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE : FAMILY SUPPORT SPECIALIST SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2009 MAR p. 2376, Eff. 12/11/09…

37.87.1345 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: CAREGIVER PEER-TO-PEER SUPPORT SPECIALIST SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2009 MAR p. 2376…

37.87.1346 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: WRAPAROUND FACILITATION SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-6-402, MCA Implementing statute(s): 53-6-402, MCA History: NEW, 2009 MAR p. 2376, Eff. 12/11/09; R…

37.87.1350 INTEGRATED CO-OCCURRING TREATMENT (ICT), DEFINITIONS "Community psychiatric supportive treatment (CPST)" means a treatment method that assists a youth and family members or other collaterals to identify strategies or treatment options associated with the youth's mental…

37.87.1351 INTEGRATED CO-OCCURRING TREATMENT (ICT), ELIGIBILITY ICT services are available to Medicaid eligible youth as defined in ARM 37.87.102. The youth must have a co-occurring substance use disorder (SUD) as defined by the most current version of the Diagnostic and Statisti…

37.87.1352 INTEGRATED CO-OCCURRING TREATMENT (ICT), REQUIREMENTS Providers of ICT must be trained in, and use, ICT as defined by the model. Providers who wish to provide ICT must undergo and pass the following provided by an entity approved by the department: a readiness assessme…

37.87.1353 INTEGRATED CO-OCCURRING TREATMENT (ICT), REIMBURSEMENT AND AUTHORIZATION A prior authorization (PA) request must be submitted to the Children's Mental Health Bureau no earlier than ten business days prior to the first date of the service for the youth. Requests receive…

37.87.1401 HOME SUPPORT SERVICES AND THERAPEUTIC FOSTER CARE, SERVICES REIMBURSEMENT Reimbursement for the therapeutic portion of home support services (HSS) and therapeutic foster care (TFC) services is the lesser of: the amount specified in the department's fee schedule adopted…

37.87.1402 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), DEFINITIONS "Behavioral Aide" means for therapeutic foster care permanency, an unlicensed employee of the mental health center who works under the supervision of the licensed mental health professional. All…

37.87.1404 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), INDIVIDUALIZED TREATMENT PLAN The individualized treatment plan (ITP) must be developed in accordance with ARM 37.106.1916. The caregiver may select the members of the ITP team. Providers must inform the yo…

37.87.1405 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), ASSESSMENTS A clinical assessment consistent with ARM 37.106.1915 must be completed for each youth documenting the youth has a serious emotional disturbance as defined in ARM 37.87.102. Authorizing statute(…

37.87.1407 THERAPEUTIC FOSTER CARE (TFC), PROVISIONS OF SERVICE The main focus of the service is to address the mental health needs and strengthen the structure and support for youth and the caregivers. TFC serves the youth and the caregivers in their home and community environme…

37.87.1408 THERAPEUTIC FOSTER CARE (TFC), DISCHARGE PLANNING AND DOCUMENTATION The youth may be discharged from this level of care based upon at least one the following criteria: the caregiver no longer needs this level of support or is actively using other formal and informal su…

37.87.1410 THERAPEUTIC FOSTER CARE (TFC), PROVIDER REQUIREMENTS The TFC provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19. The provider must also be a child-placing agency. A full-time clinical lead is responsible for not more than f…

37.87.1411 THERAPEUTIC FOSTER CARE PERMANENCY SERVICES, AUTHORIZATION REQUIREMENTS AND COVERED SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, MCA History: NEW, 2013 MAR p. 166, Eff. 2/1/13; REP, 2013 MAR p. 2153, E…

37.87.1413 THERAPEUTIC FOSTER CARE PERMANENCY SERVICES, PROVIDER PARTICIPATION Therapeutic foster care permanency (TFOC-P) services must be provided in accordance with ARM 37.87.1401 through 37.87.1408 (HSS/TFC). TFOC-P must be provided by a child placement agency in accordance w…

37.87.1414 HOME SUPPORT SERVICES (HSS), PROVISIONS OF SERVICE Home support services (HSS) providers must support the strengths of youth and caregivers by: identifying behavioral health abilities and needs across key areas such as school, family, social, community, and vocational …

37.87.1415 HOME SUPPORT SERVICES (HSS), PROVIDER REQUIREMENTS The HSS provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19. HSS teams should consist of a family support specialist (FSS) and a clinical lead. HSS providers must ensure cas…

37.87.1503 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702…

37.87.1513 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, LIMITATIONS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702…

37.87.1601 ALTERNATIVES TO OUT-OF-STATE PLACEMENT, PURPOSE The purpose of ARM 37.87.601 through 37.86.1606 is to specify provider participation and program requirements to define the basis and procedure available for placement of high-risk children to in-state services as an alte…

37.87.1602 ALTERNATIVES TO OUT-OF-STATE PLACEMENT, DEFINITIONS ″At risk″ means high-needs youth who have proven challenging for typical in-state placements, and are at risk for out-of-state placement or returning from out-of-state placement. ″Qualified provider pool″ means all in…

37.87.1604 ALTERNATIVES TO OUT-OF-STATE PLACEMENT, PROVIDER REQUIREMENTS Services funded through the program may only be provided by or through a provider that: is enrolled with the department as a Montana Medicaid provider; meets all the requirements necessary for the receipt of…