Montana Administrative Code

37.87.1606 ALTERNATIVES TO OUT-OT-STATE PLACEMENT, PROVIDER PARTICIPATION AND PROCEDURES Qualified providers and acute care hospitals may request access to the system for an alternative to out-of-state placement by supplying an OM300 form which can be obtained by contacting the D…

37.87.1703 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, COVERED SERVICES (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-2…

37.87.1723 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, PROVIDER PARTICIPATION (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701…

37.87.1733 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, PROVIDER REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701…

37.87.1801 COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM: REFERRALS Comprehensive school and community treatment (CSCT) services must be provided as set forth in ARM 37.106.1916, 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965 in order to receive paymen…

37.87.1802 COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM: CONTRACT REQUIREMENTS The licensed mental health center providing a comprehensive school and community treatment (CSCT) program must have a written contract with the school district. The licensed mental health cente…

37.87.1803 COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM: REIMBURSEMENT Comprehensive school and community treatment (CSCT) services delivered by a licensed mental health center with an endorsement under ARM 37.106.1955 must be billed under the school district's provider n…

37.87.1903 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, AUTHORIZATION REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21…

37.87.1915 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, PREMIUM PAYMENTS AND COPAYMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, 53-21-703, MCA Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, …

37.87.2103 MENTAL HEALTH SERVICES (MHS) PLAN FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, NOTICE, GRIEVANCE AND RECONSIDERATION, AND RIGHTS (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, 53-2…

37.87.2202 MENTAL HEALTH SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED) RESPITE CARE SERVICES, DEFINITION (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA History: NEW, 2009 MAR p. 272, Ef…

37.87.2203 NON-MEDICAID SERVICES PROGRAM The Children's Mental Health Bureau (CMHB) administers the Non-Medicaid Services Program for youth with serious emotional disturbance to provide the following short-term funding: Supplemental Services Program; Room and Board Account; Syste…

37.87.2205 MENTAL HEALTH SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED) NON-MEDICAID RESPITE CARE SERVICES, LIMITATIONS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA History: NEW, 2009 …

37.87.2225 MENTAL HEALTH SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED) NON-MEDICAID RESPITE CARE SERVICES, PROVIDER PARTICIPATION (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA History:…

37.87.2233 MENTAL HEALTH SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED) RESPITE CARE SERVICES, PROVIDER REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA History: NEW, 2009 MA…

37.87.303 YOUTH MENTAL HEALTH SERVICES, SERIOUS EMOTIONAL DISTURBANCE CRITERIA (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, MCA History: NEW, 2008…

37.87.701 COMMUNITY-BASED PSYCHIATRIC REHABILITATION SUPPORT 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; AMD, 2013 MAR p. 2153, Eff. 11/15/13; REP, 2014 MAR p. 285…

37.87.702 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), DEFINITIONS For purposes of this subchapter, the following definitions apply: "Community-based psychiatric rehabilitation and support (CBPRS)" means rehabilitation services provided in hom…

37.87.703 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), COVERED SERVICES Mental health center services for youth with SED include: Community-Based Psychiatric Rehabilitation and Support (CBPRS) services as defined in ARM 37.87.702. Comprehensiv…

37.87.705 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, NONCOVERED SERVICES Mental health professional services, provided in a hospital on an inpatient basis, that are covered by Medicaid as part of the diagnosis related group (DRG) payment under ARM…

37.87.723 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), PROVIDER REQUIREMENTS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-101, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, MCA History: NEW, 2009 MAR p. 272, Eff. 2/…

37.87.733 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), REIMBURSEMENT Medicaid reimbursement for mental health center services shall be the lesser of: the provider's actual (submitted) charge for the service; or the rate established in the depa…

37.87.802 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, DEFINITIONS As used in this chapter, the following terms apply: "Department" means the Department of Public Health and Human Services. "Natural supports" means relationships and supports tha…

37.87.805 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, ELIGIBILITY If otherwise eligible for Medicaid services, youth with SED may receive medically necessary targeted case management services in the community setting or when transitioning to a …

37.87.807 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, COVERED SERVICES Targeted case management services include: comprehensive assessment and periodic reassessment of an eligible youth and the youth's family or caregivers to determine the need…

37.87.808 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, AUTHORIZATION REQUIREMENTS Targeted case management services for youth with SED do not require prior authorization to be reimbursed. Authorizing statute(s): 53-2-201, 53-6-113, MCA Implement…

37.87.809 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, REIMBURSEMENT Targeted case management (TCM) services for youth with SED will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is based on a 15-…

37.87.823 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, PROVIDER REQUIREMENTS The requirements in this subchapter are in addition to those contained in provisions generally applicable to Medicaid providers. Targeted case management services for y…

37.87.901 MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, REIMBURSEMENT Medicaid reimbursement for mental health services will be the lowest of: the provider's actual (submitted) charge for the service; or the rate established in the department's fee schedule. Reimbursement fees are a…

37.87.903 MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, AUTHORIZATION REQUIREMENTS The department will not reimburse providers for two services that duplicate one another on the same day. The department will reimburse providers of Medicaid mental health youth services if they meet t…

37.88.101 MEDICAID MENTAL HEALTH SERVICES FOR ADULTS, AUTHORIZATION REQUIREMENTS Mental health services for a Medicaid adult under the Montana Medicaid program will be reimbursed only if the client is 18 or more years of age and has been determined to have a severe disabling ment…

37.88.110 TEMPORARY RATE ADJUSTMENT (REPEALED) Authorizing statute(s): 53-6-113, 53-21-201, MCA Implementing statute(s): 53-6-101, 53-6-113, 53-21-201, MCA History: EMERG, NEW, 2002 MAR p. 1328, Eff. 4/26/02; REP, 2018 MAR p. 725, Eff. 5/1/18.

37.88.1101 INPATIENT PSYCHIATRIC SERVICES, PURPOSE (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 989, …

37.88.1102 INPATIENT PSYCHIATRIC SERVICES, DEFINITIONS (REPEALED) Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 2360, E…

37.88.1105 INPATIENT PSYCHIATRIC SERVICES, PARTICIPATION REQUIREMENTS (REPEALED) Authorizing statute(s): 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; REP, 2008 MAR…

37.88.1106 INPATIENT PSYCHIATRIC SERVICES, REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p.…

37.88.1107 INPATIENT PSYCHIATRIC SERVICES, COST SETTLEMENT AND UNDERPAYMENT (REPEALED) Authorizing statute(s): 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; REP, 20…

37.88.1110 SERVICE ACCESS RATE ADJUSTMENT PAYMENT, ELIGIBILITY AND COMPUTATION (REPEALED) Authorizing statute(s): 53-6-113, 53-21-201, MCA Implementing statute(s): 53-6-101, 53-6-113, 53-21-201, MCA History: NEW, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2003 MAR p. 1087, Eff. …

37.88.1111 DIRECT CARE WAGE ADD-ON FOR CERTAIN MENTAL HEALTH CARE PROVIDERS (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 2006 MAR p. 1635, Eff. 6/23/06; REP, 2008 MAR p. 1160, Eff. 6/…

37.88.1115 INPATIENT PSYCHIATRIC SERVICES, ADMINISTRATIVE REVIEW AND FAIR HEARING PROCEDURES (REPEALED) Authorizing statute(s): 2-4-201, 53-6-113, MCA Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS,…

37.88.1116 INPATIENT PSYCHIATRIC SERVICES, CERTIFICATION OF NEED FOR SERVICES, UTILIZATION REVIEW AND INSPECTIONS OF CARE (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 1999 MAR p. 1301…

37.88.1119 INPATIENT HOSPITAL PSYCHIATRIC CARE (REPEALED) Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 2360, Eff. 1/1/09.

37.88.1121 INPATIENT PSYCHIATRIC SERVICES (REPEALED) Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 2360, Eff. 1/1/09.

37.88.1125 INPATIENT PSYCHIATRIC HOSPITALS, REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 2360, Eff. 1/1/09.

37.88.1129 RESIDENTIAL PSYCHIATRIC CARE (REPEALED) Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 2360, Eff. 1/1/09.

37.88.1131 HOSPITAL BASED RESIDENTIAL TREATMENT CENTERS, REQUIREMENTS (REPEALED) Authorizing statute(s): 2-4-201, 53-2-201, 53-6-113, MCA Implementing statute(s): 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 23…

37.88.1133 RESIDENTIAL TREATMENT CENTERS, REIMBURSEMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; AMD, 2006 MAR p. 1635, Eff. 6/23/06; REP, 2008 MAR …

37.88.1137 RESIDENTIAL TREATMENT CENTERS, CONTINUITY OF CARE PAYMENT (REPEALED) Authorizing statute(s): 53-2-201, 53-6-113, MCA Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-149, MCA History: NEW, 2004 MAR p. 1328, Eff. 6/4/04; REP, 2008 MAR p. 2360, Eff. …

37.88.1401 INSTITUTIONS FOR MENTAL DISEASES, PURPOSE ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 specify requirements for the provision of and reimbursement for medicaid nursing facility and hospital services to medicaid recipients wh…

37.88.1402 INSTITUTIONS FOR MENTAL DISEASES, DEFINITIONS In ARM 37.88.1401, 37.88.1402, 37.88.1405, 37.88.1406, 37.88.1410, 37.88.1411 and 37.88.1420 the following definitions apply: "Department" means the Montana department of public health and human services or its agents, incl…