As used in this chapter, the following terms apply:

(1) "Licensed mental health center" means a mental health center licensed in accordance with ARM 37.106.1906 through 37.106.1965.

(2) "Medically necessary service" for Medicaid is defined in ARM 37.82.102.

(3) "Mental health professional" means one of the following practitioners:

(a) physician;

(b) licensed professional counselor;

(c) licensed psychologist;

(d) licensed clinical social worker;

(e) licensed marriage and family therapist; or 

(f) advanced practice registered nurse, with a clinical specialty in psychiatric mental health nursing.

(4) "Provider" means a person or entity that has enrolled and entered into a provider agreement with the department in accordance with the requirements of ARM 37.85.401 through 37.85.513 to provide mental health services to youth with SED on Medicaid.

(5) "Provider agreement" means the written enrollment agreement entered into between the department and a person or entity to provide mental health services to youth with SED.

(6) "Serious Emotional Disturbance (SED)" criteria are defined in the Children's Mental Health Bureau, Medicaid Services Provider Manual as adopted and incorporated by reference in ARM 37.87.903.

(7) "System of Care Account" is defined in 52-2-309, MCA, and allows the department to fund via the state special revenue fund the administering and delivering of services to high-risk youth with multiagency service needs and to provide for the youth's care, protection, and mental, social, and physical development.

(8) "Youth" means, for Medicaid services, a person 17 years of age and younger or a person who is up to 20 years of age and is enrolled in an accredited secondary school. A youth may receive Psychiatric Residential Treatment Facility services through the age of 17.

This rule has been repealed.

This rule has been repealed.

For purposes of this subchapter, the following definitions apply:

(1) "Community-based psychiatric rehabilitation and support (CBPRS)" means rehabilitation services provided in home, school, and community settings for youth with serious emotional disturbance (SED) who are at risk of out of home or residential placement, or risk removal from current setting for youth under six years of age. CBPRS services are provided for a short period of time, generally 90 days or less, to improve or restore the youth's functioning in one or more of the impaired areas identified in the SED definition in ARM 37.87.102. Services are provided by trained mental health personnel under the supervision of a licensed mental health professional and according to rehabilitation goals.

(2) "Comprehensive school and community treatment" is defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(3) "In-training mental health professional services" are services provided under the supervision of a licensed mental health professional by an individual who has completed all academic requirements for licensure as a psychologist, clinical social worker, licensed professional counselor, or licensed marriage and family therapist and is in the process of completing the supervised experience requirement for licensure, in accordance with ARM Title 24, chapters 189 and 219.

(4) "Licensed mental health center" is defined in ARM 37.87.102. For purposes of this subchapter the following provisions also apply:

(a) For a mental health center to be licensed, there are specific services that must be provided to its clients in accordance with ARM 37.106.1906.

(b) A mental health center may provide other appropriate services with an endorsement by the department in accordance with ARM 37.106.1906.

(5) "Mental health center services for youth with serious emotional disturbance" reimbursed by Medicaid means community-based psychiatric rehabilitation and support services, comprehensive school and community treatment programs, day treatment services, in-training mental health professional services, outpatient therapy services, mental health professional services, and targeted case management services.

(6) "Mental health professional" is defined in ARM 37.87.102.

(7) "Outpatient therapy service" is defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(8) "Serious emotional disturbance (SED)" criteria are defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(9) "Treatment day" means a calendar day, including night, daytime, or evening, during which a youth receives services according to applicable requirements.

(10) "Youth" is defined in ARM 37.87.102.

(11) "Youth day treatment" means a program which provides, in accordance with mental health center license requirements, an integrated set of mental health, education, and family intervention services to youth with serious emotional disturbance.

(1) Mental health center services for youth with SED include:

(a) Community-Based Psychiatric Rehabilitation and Support (CBPRS) services as defined in ARM 37.87.702.

(b) Comprehensive school and community treatment in accordance with ARM Title 37, chapter 87, subchapter 18.

(c) Youth day treatment services as defined in ARM 37.87.702.

(d) In-training mental health professional services as defined in ARM 37.87.702. Services are subject to the same requirements that apply to licensed mental health professionals.

(e) Outpatient therapy services provided according to an individualized treatment plan and such services must include:

(i) psychotherapy services provided in accordance with the current edition of the American Medical Association's Current Procedural Terminology, Professional Edition, and codes approved by the department. The department adopts and incorporates by reference this manual;

(ii) family therapy, provided with or without the youth present, directed at the eligible youth's mental health needs and their impact on the family dynamics; and

(iii) individual and family therapy are targeted at reducing or eliminating symptoms or behaviors related to a youth's mental health diagnosis as specified in the treatment plan.

(f) Targeted case management (TCM) services as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(g) Mental health professional services, which include the professional component of physician or psychiatrist services covered in ARM 37.86.101, 37.86.104, and 37.86.105. Mental health professional services are subject to the following limitations:

(i) To the extent otherwise permitted by applicable Medicaid rules, such mental health professional services may be billed either by the mental health center as mental health center services or by the mental health professional under the applicable Medicaid category of service, but may not be billed as both mental health center services and mental health professional services.

(ii) Mental health professional services may be covered and reimbursed by Medicaid only if the mental health professional is enrolled as a provider and the services are provided according to the Medicaid rules and requirements applicable to the mental health professional's category of service.

(h) Home support services (HSS) and therapeutic foster care (TFC) as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(i)  Mental health intensive outpatient therapy (IOP) as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(1) 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 37.86.2907 are not reimbursable as mental health center services. These noncovered services include:

(a) mental health professional services provided by mental health professionals who are staff members of a mental health center which has a contract with a hospital involving consideration;

(b) services provided for purposes of discharge planning as required by 42 CFR part 482.43; and

(c) services including but not limited to group therapy that are required as a part of hospital licensure or certification.

This rule has been repealed.

(1) Medicaid reimbursement for mental health center services shall be the lesser of:

(a) the provider's actual (submitted) charge for the service; or

(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.105.

(2) For day treatment services, the department will not reimburse a mental health center provider for more than one fee per treatment day per youth. This does not apply to mental health professional services to the extent such services are separately billed in accordance with these rules or targeted case management services for youth with SED.

As used in this chapter, the following terms apply:

(1) "Department" means the Department of Public Health and Human Services.

(2) "Natural supports" means relationships and supports that occur within the community in everyday life including but not limited to relationships with family members, friends, neighbors, and community acquaintances.

(3) "Targeted case management services (TCM)" means case management as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(4) The definitions in ARM 37.86.3301 also apply when not inconsistent with this subchapter.

(1) 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 community setting as provided in this subchapter.

(1) Targeted case management services include:

(a) comprehensive assessment and periodic reassessment of an eligible youth and the youth's family or caregivers to determine the need for any medical, educational, social, or other services. The assessment activities include the following:

(i) taking youth and the youth's family or caregivers history;

(ii) identifying the needs of the youth and the youth's family or caregivers, and completing related documentation; and

(iii) gathering necessary information from other sources, such as family members, medical providers, social workers, and educators to make a complete assessment of the eligible youth.

(b) development and periodic revision of a specific care plan based on the information collected through the assessment that includes the following:

(i) specific goals and actions to address the service needs of the youth and the youth's family or caregivers, including but not limited to medical, social, and educational needs;

(ii) the active participation of the eligible youth and the youth's family or caregivers in developing the goals and actions of the care plan; and

(iii) a course of action designed to respond to the assessed needs of the eligible youth and the youth's family or caregivers.

(c) referral and related activities, such as making referrals and scheduling appointments for the youth, helping the eligible youth and the youth's family or caregivers obtain needed services, helping to link the youth and the youth's family or caregivers with medical, social, and educational providers or other programs and services that provide needed services to address identified needs and achieve goals specified in the care plan; and

(d) monitoring and follow-up activities, including activities and contacts necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible youth and the youth's family or caregivers. The monitoring and follow-up activities may be with the youth, family members or caregivers, service providers, or other entities or individuals and may be conducted as frequently as necessary, including at least one annual monitoring review to help determine whether the following conditions are met:

(i) services are being furnished in accordance with the youth's care plan;

(ii) services in the care plan are adequate to meet the needs of the youth and youth's family or caregivers; and

(iii) changes in the needs or status of the eligible youth have been accommodated. Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers.

(2) Targeted case management may include contacts with noneligible individuals who are directly related to the identification of the eligible youth's needs and care for the purpose of helping the youth access services, identifying needs and supports to assist the eligible youth in obtaining services, providing case managers with useful feedback, and alerting case managers to changes in the eligible youth's needs.

(1) Targeted case management services for youth with SED do not require prior authorization to be reimbursed.

(1) 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-minute unit increment:

(a) one unit of service is equal to 8 minutes but less than 23 minutes;

(b) two units of service are greater than or equal to 23 minutes but less than 38 minutes;

(c) three units of service are greater than or equal to 38 minutes but less than 53 minutes;

(d) four units of service are greater than or equal to 53 minutes but less than 68 minutes;

(e) five units of service are greater than or equal to 68 minutes but less than 83 minutes;

(f) six units of service are greater than or equal to 83 minutes but less than 98 minutes;

(g) seven units of service are greater than or equal to 98 minutes but less than 113 minutes; and

(h) eight units of service are greater than or equal to 113 minutes but less than 128 minutes.

(2) Targeted case management services rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.106.

(3) The department will pay providers of targeted case management services for youth with SED the lesser of:

(a) the provider's actual submitted charge for services; or

(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.106.

(4) Case managers may not bill for time spent writing progress notes. This activity is included in the rate for TCM services.

(5) TCM services may be billed whether provided face-to-face or by telephone.

(1) The requirements in this subchapter are in addition to those contained in provisions generally applicable to Medicaid providers.

(2) Targeted case management services for youth with SED must be provided by a licensed mental health center as defined in ARM 37.87.102. A mental health center must:

(a) have a current license endorsement permitting the mental health center to provide targeted case management services; and

(b) be enrolled in the Montana Medicaid program as a targeted case management services provider.

(3) Targeted case management services for youth with SED must be supported by narrative documentation in accordance with ARM 37.85.414 record keeping requirements.

(4) Targeted case management services for youth with SED must be provided under a case management plan in accordance with ARM 37.86.3305.

(5) Case management plans for youth with SED must be completed within the first 21 days of admission to targeted case management services and updated at least every 90 days or whenever there is a significant change to the youth's condition. The case management plan must:

(a) use the standardized assessment tool approved by the department to determine the appropriate level of service intensity needed by the youth and the youth's family or caregivers;

(b) incorporate standardized assessment tool findings into the plan;

(c) support continued benefits from TCM reflected in youth service planning;

(d) reflect the least restrictive and appropriate level of care;

(e) identify the strengths of the youth and the youth's family or caregivers;

(f) include a crisis response plan;

(g) include a plan for each youth age 16 1/2 and older to transition to adult mental health services; and

(h) include a discharge and transition plan from targeted case management services.

(6) Upon admission to TCM services and prior to all treatment team meetings of TCM services, the targeted case manager shall meet face-to-face with the youth's family or caregivers to complete a family treatment team meeting preparation checklist and questionnaire. If the meeting cannot be accomplished face-to-face, the targeted case manager shall document in the youth's file the reason for conducting the meeting through phone contact or telehealth. The checklist and questionnaire must contain and document the following components:

(a) explanation of the purpose of the treatment meeting and documentation of the youth's family or caregivers understanding;

(b) identification of natural supports in the youth's life;

(c) a notice to the family that the youth's treatment plan shall be delivered at times and in locations that are flexible, accessible, and convenient to the youth and the youth's family or caregivers, including evenings and weekends;

(d) evaluation with the youth and the youth's family or caregivers to identify and address risks and safety concerns at home and in the school and in the community; and

(e) evaluation with the youth and the youth's family or caregivers to identify strengths that can be used as the basis of the treatment plan in the areas of school, vocational, family, social, and community functioning as well as towards meeting developmental skills and abilities.

(7) Individual treatment plans and those participating in treatment team meetings must:

(a) use language that is understandable to the youth and the youth's family or caregivers and, where necessary, translate clinical terminology including but not limited to diagnoses and acronyms into language that is understandable; and

(b) actively seek to understand and demonstrate respect for the unique and diverse backgrounds of the youth and the youth's family or caregivers including but not limited to roles, values, beliefs, races, ethnicities, sexual orientations, gender expressions, gender identities, languages, traditions, communities, and cultures.

(8) In addition to the requirements outlined in (7), individual treatment plans must include:

(a) identification of natural supports or treatment goals intended to develop natural supports; and

(b) a crisis plan that identifies safety concerns, potential crises, triggers, de-escalation and coping strategies, actionable stabilization steps, prevention measures, and identified supports of the youth and the youth's family or caregivers.

(9) Targeted case management providers shall share with the youth and the youth's family or caregivers baseline and updated outcome measurements including measurements of the youth's emotional and behavioral functioning, living situation, school outcomes, risk of harm to self or others, substance use, and progress toward individualized goals. Targeted case management providers shall meet with the youth and the youth's family or caregivers at least every 90 days for the purpose of sharing this information.

(10) In addition to the discharge requirements outlined in ARM 37.106.1917, a youth must be discharged from targeted case management services when treatment plan goals have been met, when the youth no longer desires targeted case management, or when the youth no longer meets the criteria for entry into targeted case management services.

(11) Mental health centers with a youth targeted case management endorsement must have policies and procedures in place to provide timely access to services for youth by:

(a) ensuring mental health centers have adequate resources to provide timely access to the standard assessment tool for intake of youth; and

(b) detailing a communication plan to the youth's family or caregivers if the youth is placed on a waitlist, including a process for referral to other services providers.

(1) Medicaid reimbursement for mental health services will be the lowest of:

(a) the provider's actual (submitted) charge for the service; or

(b) the rate established in the department's fee schedule. Reimbursement fees are as provided in ARM 37.85.105(6).

(2) For services for which Medicare does not specify Relative Value Unit (RVU) as provided in ARM 37.85.212, the department determines the Medicaid fee for children's mental health services as follows:

(a) if there is use resulting in Medicaid reimbursements totaling at least $10,000 in a state fiscal year (SFY), and a minimum of four separate providers have billed the code, then the Medicaid fee is determined by multiplying the average charges by the payment-to-charge ratio; or

(b) if there is use resulting in Medicaid reimbursements totaling less than $10,000 in an SFY and fewer than four separate providers have billed the code in an SFY, the Medicaid fee will be determined by:

(i) reviewing similar procedure codes within the same service scope and adjusting the rate to be equal to a comparable procedure code or the average of similar procedure codes if there is more than one; or

(ii) reviewing similar procedure codes within the same service scope and adjusting the rate to be equal to a comparable procedure code or the average of similar codes plus 10% when severity is higher or increased resources are needed for the service. If the code is determined to have a lower severity component or fewer resources are required than when compared to the similar procedure code or average of similar procedure codes, the rate will equal the comparable procedure code or average of similar procedure codes less 10%.

(1) The department will not reimburse providers for two services that duplicate one another on the same day.

(2) The department will reimburse providers of Medicaid mental health youth services if they meet the prior authorization or continued stay review requirements specified in the Children's Mental Health Medicaid Services Provider Manual, referenced in (7).

(3) Youth are not required to have a serious emotional disturbance to receive the following outpatient therapy services:

(a) the first 24 sessions of individual, family, or both outpatient therapies per state fiscal year. Group outpatient therapy is not included in the 24-session limit; and

(b) group outpatient therapy.

(4) The department may waive a requirement for prior authorization or continued authorization when the provider submits documentation that:

(a) there was a clinical reason why the request for prior authorization or continued authorization could not be made at the required time, and the provider submitted a subsequent authorization request within ten business days; or

(b) a timely request for prior authorization or continued authorization was not possible because of an equipment failure or malfunction of the department or its designee that prevented the transmittal of the request at the required time and the provider submitted a subsequent authorization request within ten business days.

(5) In computing any time period specified in this subchapter, every day is counted, including Saturdays, Sundays, and legal holidays. If the last day falls on a weekend or holiday, the deadline is the next business day.

(6) If the department finds exceptional circumstances that reasonably justify a provider's failure to timely request prior authorization or continued authorization, it may extend the deadline for meeting the requirement.

(7) In addition to the requirements contained in rule, the department has developed and published a provider manual entitled Children's Mental Health Medicaid Services Provider Manual (manual), dated May 12, 2023, for the purpose of implementing requirements for utilization management. The department adopts and incorporates by reference the Children's Mental Health Medicaid Services Provider Manual, dated May 12, 2023. A copy of the manual may be obtained at https://dphhs.mt.gov/bhdd/cmb/Manuals.

(8) The department may review the medical necessity of services or items at any time either before or after payment in accordance with the provisions of ARM 37.85.410. If the department determines that services or items were not medically necessary or were otherwise not in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.

(9) The department or its designee may require providers to report outcome data or measures regarding mental health services, as determined in consultation with providers and interested persons. 

(1) The requirements in this subchapter are in addition to those requirements contained in rules generally applicable to Medicaid providers.

(2) Therapeutic group home (TGH) services may be provided by an in-state facility which is licensed as a TGH by the department in accordance with the provisions of Title 52, chapter 2, part 6, MCA, and found in ARM 37.87.1011, 37.87.1017, and the manual adopted and incorporated by reference in ARM 37.87.903, or by an out-of-state facility similarly licensed in the state in which it operates.

(3) TGH services must be provided to a youth in accordance with an individualized treatment plan developed and maintained as specified by licensure requirements and this subchapter.

(4) In addition to the clinical records required by TGH licensure rules, the provider must maintain the records required by ARM 37.85.414.

(1) For the purpose of this subchapter, the following definitions apply:

(a) "Patient day" means a whole 24-hour period that a youth is present and receiving TGH services. Even though a youth may not be present for a whole 24-hour period, the day of admission is a patient day. The day of discharge is not a patient day.

(b) "Therapeutic intervention" is defined in ARM 37.97.102(23).

(c) "Therapy" is defined in ARM 37.97.102(26).

(2) The reimbursement rate for the therapeutic and rehabilitative portion of TGH or TGH with extraordinary needs aide (ENA) services is the lesser of (1)(a) or (b):

(a) the amount specified in the department's Medicaid Mental Health Fee Schedule as adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(3) The purpose of the therapeutic services in (1) is:

(a) to reduce the impairment of the mental disability of the youth and to improve the functional level of the youth;

(b) to alleviate the emotional disturbances;

(c) to reverse or change maladaptive patterns of behavior; and

(d) to encourage personal growth and development.

(4) TGHs are reimbursed a daily or patient day rate.

(5) TGH providers must use the procedure codes designated by the department, per the fee schedule in (1)(a) to be reimbursed for TGH, TGH with ENA, or TGH therapeutic home visit (THV) services.

(6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of TGH services.

(7) Reimbursement will be made to a provider for reserving a TGH bed while the youth is temporarily absent for a THV for a maximum of 14 patient days per state fiscal year.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The purpose of ARM Title 37, chapter 87, subchapter 12 is to specify provider participation and program requirements and to define the basis and procedure the department will use to pay for psychiatric residential treatment facility (PRTF) services.

(2) Facilities in which these services are available are referred to as providers.

As used in this subchapter, the following definitions apply:

(1) "Continuity of care payment" means an annual payment made to qualifying hospital-based psychiatric residential treatment facilities (PRTF) according to the eligibility criteria and payment calculation methodology in ARM 37.87.1224.

(2) "Devoted to the provision of inpatient psychiatric care for persons under the age of 21" means an inpatient psychiatric hospital facility or residential treatment facility whose goals, purpose, and care are designed for and devoted exclusively to persons under the age of 21.

(3) "Hospital-based psychiatric residential treatment facility" means a residential treatment facility that meets the requirements of ARM 37.87.1207.

(4) "Inpatient psychiatric services" means psychiatric residential treatment facility services, or hospital-based psychiatric residential treatment facility services.

(5) "Patient day" means a whole 24-hour period in which a person is present and receiving inpatient psychiatric services. Even though a person may not be present for a whole 24-hour period, the day of admission and, subject to the limitations and requirements of ARM 37.87.1223, therapeutic home leave days are patient days. The day of discharge is not a patient day for purposes of reimbursement.

(6) "Psychiatric residential treatment facility (PRTF)" is defined in the Children's Mental Health Bureau Medicaid Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

(7) "Therapeutic Home Visit (THV)" is defined in the Children's Mental Health Bureau Medicaid Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

(1) Inpatient psychiatric services are services that comply with the requirements of this subchapter and the applicable federal regulations and are provided in a psychiatric residential treatment facility (PRTF) that is devoted to the provision of inpatient psychiatric care for persons under the age of 21.

(2) 42 CFR 440.160 and Title 42 CFR, part 441, subpart D provide federal definitions and federal PRTF program requirements. The department adopts and incorporates by reference 42 CFR 440.160 (2010) and Title 42 CFR, part 441, subpart D (2010). A copy of the regulations may be obtained through the Department of Public Health and Human Services, Developmental Services Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59620-4210.

(1) These requirements are in addition to those contained in rule generally applicable to Medicaid providers.

(2) Psychiatric residential treatment facility (PRTF) providers, as a condition of participation in the Montana Medicaid program, must comply with the following requirements:

(a) maintain a current license as a residential treatment facility under the rules of the department's Quality Assurance Division to provide PRTF services, or, if the provider's facility is not located within the state of Montana, maintain a current license in an equivalent category under the laws of the state in which the facility is located;

(b) maintain a current PRTF certification for Medicaid participation by the state in which the facility is located as required by the Centers for Medicare and Medicaid;

(c) for all providers, enter into and maintain a current provider enrollment form with the department's fiscal agent to provide psychiatric PRTF services;

(d) license and/or register facility personnel in accordance with applicable state and federal laws;

(e) for providers maintaining patient trust accounts, ensure that any funds maintained in those accounts are used only for those purposes for which the youth or legal representative has given written authorization. A provider may not borrow funds from these accounts for any purpose;

(f) maintain accreditation as a PRTF by an organization designated by the Secretary of the United States Department of Health and Human Services as authorized to accredit PRTF for Medicaid participation;

(g) submit to the department within 30 days of receipt, all documentation issued by the accrediting organization to the provider;

(h) agree to indemnify the department in the full amount of the state and federal shares of all Medicaid inpatient psychiatric services reimbursement paid to the facility during any period when federal financial participation is unavailable due to facility failure to meet the conditions of participation specified in these rules or due to other facility deficiencies or errors.

(1) A hospital-based psychiatric residential treatment facility (PRTF) must meet the following requirements:

(a) the PRTF must be in a hospital facility that includes inpatient psychiatric hospital beds and provides inpatient hospital psychiatric care to individuals under age 21. The PRTF beds and the hospital beds must be owned and operated by a single entity, and they must be located in an integrated facility;

(b) the PRTF must be located in Montana;

(c) the inpatient psychiatric hospital beds and the PRTF beds must be served by a common administrative and support staff;

(d) the PRTF must be served by no less than one full-time equivalent psychiatrist for every 25 youth;

(e) both the hospital and the PRTF must have an organized medical staff that is on call and available within 20 minutes, 24 hours a day, seven days a week; and

(f) both the hospital and the PRTF must have 24-hour nursing care by licensed registered nurses.

This rule has been repealed.

This rule has been repealed.

(1) 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 regulations for PRTF services.

(2) PRTF assessment services:

(a) require prior authorization by the department or its designee;

(b) are short-term lengths of stay, 14 days or less;

(c) are reimbursed 15% higher than the department's current Medicaid Youth Mental Health Fee Schedule for PRTF Services.

(3) Assessment services include the following, as clinically indicated:

(a) diagnostic and functional assessment;

(b) medication evaluation;

(c) psychological and IQ testing;

(d) substance use disorder assessment; and

(e) supported group or independent living needs assessment.

(4) Assessment services include a written report within 14 days after the discharge that includes clear recommendations for treatment of the youth.

(5) If the PRTF admission continues beyond the assessment period and becomes a regular admission, the department will not reimburse at the higher rate for assessment services.

(a) If the youth is re-admitted to the facility within 30 days of the assessment, the admission for assessment may be subject to department review and full recovery.

(1) Prior to admission and as frequently as the department deems necessary, the department or its agents may evaluate the medical necessity and quality of services for each Medicaid member.

(a) In addition to the other requirements of these rules, the provider must provide to the department or its agent upon request any records related to services or items provided to a Medicaid member.

(b) The department may contract with and designate public or private agencies or entities, or a combination of public and private agencies and entities, to perform utilization review, inspections of care, and other functions under this rule as an agent of the department.

(2) The department or its agents may conduct periodic inspections of care in PRTFs participating in the Medicaid program.

(3) A provider must submit a certificate of need as described in the Children's Mental Health Bureau Medicaid Services Manual, adopted and incorporated by reference in ARM 37.87.903.

(4) An authorization by the department or its utilization review agent under this rule is not a final or conclusive determination of medical necessity and does not prevent the department or its agents from evaluating or determining the medical necessity of services or items at any time.

(1) 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.

(2) PRTF services must be provided under the direction of a licensed physician.

(3) The PRTF treatment plan must be comprehensive and address all psychiatric, medical, educational, psychological, social, behavioral, and developmental treatment needs.

(4) The treatment plan and discharge plan for the youth must be reviewed at least every 30 days at the multidisciplinary treatment team meeting, and more frequently if there is a significant change in the condition of the youth. The multidisciplinary treatment team must be consistent with 42 CFR 441.156. The parent or legal representative of the youth must be invited to participate in these meetings, and given adequate notice to participate. Adequate notice means generally a week unless the condition of the youth dictates otherwise.

(5) PRTF services include only treatment or services provided in accordance with all applicable licensure, certification, and accreditation requirements, and these rules.

(6) The content of the treatment plan and discharge plan must meet all minimum state and federal requirements.

This rule has been repealed.

(1) 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, which is consistent with the definition of a PRTF and all other applicable requirements are met.

(2) The Montana Medicaid Program will pay a provider for each Medicaid patient day, the following bundled per diem rate less any third party or other payments. The bundled per diem rate for in-state PRTF services is the lesser of:

(a) the amount specified in the department's Medicaid Youth Mental Health fee schedule, as adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(3) The bundled per diem rate for in-state PRTFs coverage includes the following services:

(a) services, therapies, and items related to treating the psychiatric condition of the youth;

(b) services provided by licensed psychologists, licensed clinical social workers, and licensed professional counselors;

(c) psychological testing;

(d) lab and pharmacy services related to treating the psychiatric condition of the youth; and

(e) supportive services necessary for daily living and safety.

(4) A direct-care wage add-on is reimbursed in addition to the in-state per diem through a contract with the department or in the bundled per diem rate, as applicable.

(5) The Montana Medicaid Program will reimburse enrolled providers directly for the following services which are not included in the in-state per diem rate:

(a) services provided by a licensed physician, psychiatrist, or midlevel practitioner;

(b) non-psychotropic medication and related lab services;

(c) adult mental health center evaluations for transition age youth 17 to 18, to determine whether or not they qualify for adult mental health services and have a severe and disabling mental illness; and

(d) up to 60 consecutive days of targeted case management services for the purpose of planning the youth's transition to the community. A youth should retain the case manager the youth had prior to entry into PRTF services, if applicable. If the youth is assigned a case manager who is different from the one previous to PRTF services, the case manager must document the rationale for the change.

(6) The Montana Medicaid Program will reimburse state plan ancillary services in addition to the in-state PRTF bundled per diem rate when these ancillary services are provided by a PRTF or by a different provider under arrangement with the PRTF. The ancillary services provided must be:

(a) directed by a PRTF physician;

(b) stated in the treatment plan of the youth; and

(c) maintained in the medical records for the youth. 

(1) Hospital-based psychiatric residential treatment facilities as defined in ARM 37.87.1207 qualify for a continuity of care payment.

(a) The amount of the continuity of care adjustor payment will be calculated and paid annually.

(b) The amount will be determined by the department according to the following formula: CCA=[M/D]*P:

(i) "CCA" represents the calculated continuity of care payment;

(ii) "M" is the number of Medicaid inpatient residential days provided by the facility for which the continuity of care payment is being calculated;

(iii) "D" is the total number of Medicaid inpatient residential days provided by all eligible facilities; and

(iv) "P" is the total amount available for distribution via the continuity of care payments. P equals 4% of the revenue generated by the Montana inpatient hospital utilization fee, plus federal financial participation.

(2) The number of Medicaid days must be from the department's paid claims data for the most recent calendar year.

(1) 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 accordance with the requirements of this subchapter and the Children's Mental Health Bureau Medicaid Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

(2)  The Montana Medicaid Program will reimburse a provider for each Medicaid patient day the following bundled per diem rate less any third party or other payments.  The bundled per diem rate for out-of-state PRTF services is the lesser of:

(a)  the amount specified in the department's Medicaid Youth Mental Health fee schedule, as adopted in ARM 37.85.105; or

(b)  the provider's usual and customary charges.

(3) The bundled per diem rate for out-of-state PRTFs services coverage includes the following services:

(a) all services, therapies, and items related to treating the psychiatric condition of the youth;

(b) all services provided by licensed physicians, psychiatrists, midlevel practitioners, psychologists, clinical social workers, and professional counselors;

(c) psychological testing;

(d) lab and pharmacy services; and

(e) supportive services necessary for daily living and safety.

(4) The Montana Medicaid Program will reimburse enrolled providers directly for the following services which are not included in the out-of-state per diem rate:

(a) up to 60 consecutive days of targeted case management services for the purpose of planning the youth's transition to the community. A youth should retain the case manager the youth had prior to entry into PRTF services, if applicable. If the youth is assigned a case manager who is different from the one previous to PRTF services, the case manager must document the rationale for the change; and

(b) a clinical intake assessment by a licensed mental health center, with an endorsement to provide adult services for transition age youth 17 to 18, to determine whether they have a severe and disabling mental illness and if they qualify for adult mental health services.

(5) The Montana Medicaid Program will reimburse state plan ancillary services in addition to the out-of-state bundled per diem rate when these ancillary services are provided by a different provider under arrangement with the PRTF. The ancillary services provided must be:

(a) directed by the PRTF physician;

(b) stated in the treatment plan of the youth; and

(c) documented in the medical records for the youth.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) "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 illness, with the goal of minimizing the negative effects of mental illness symptoms or emotional disturbances or associated environmental stressors which interfere with the youth's daily living, financial management, housing, academic or employment progress, personal recovery or resilience, family or interpersonal relationships, and community integration.

(2) "Fidelity" means adherence to the integrated co-occurring treatment (ICT) model, defined in (3). A program which adheres to the ICT model is more likely to replicate the positive outcomes of the model's initial implementation or testing.

(3) "Integrated co-occurring treatment (ICT) model" means the ICT model developed by the Center for Innovative Practices at Case Western Reserve University. Services are provided to the fidelity of the model in the home or community where the youth lives, with the goal of safely maintaining the youth in the least restrictive, most normative environment. The frequency and intensity of services may fluctuate based on the needs and unique circumstances of the youth and family. ICT provides a family driven, comprehensive mix of integrated services designed to meet the mental health and substance abuse needs of the youth through implementation of the following services:

(a) ICT therapeutic interventions as described in (6); and

(b) CPST as described in (1).

(4) "ICT clinical supervisor" means a person who is an employee of a provider agency who is dually licensed as a mental health professional, as defined in ARM 37.87.102(3) and is a licensed addiction counselor (LAC), under 37-35-202, MCA.

(5) "ICT clinician" means a person who is an employee of a provider agency who:

(a) is licensed as a mental health professional, as defined in ARM 37.87.102(3), or is an in-training mental health professional, as defined in ARM 37.87.702(3); and

(b) is a LAC, or is a candidate for licensure, under 37-35-202, MCA, or will meet the requirements for candidacy under 37-35-202, MCA, within one year of hire and has completed ICT approved core training.

(6) "ICT therapeutic interventions" means crisis response and management; individual and family counseling matched to assessed readiness to change and assessed ability of youth and family, not to include group therapy; and behavioral management and skill training matched to assessed ability of youth and family.

(1) ICT services are available to Medicaid eligible youth as defined in ARM 37.87.102.

(2) The youth must have a co-occurring substance use disorder (SUD) as defined by the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and a serious emotional disturbance (SED) as defined in the manual, adopted and incorporated by reference in ARM 37.87.903.

(3) The youth must undergo an integrated bio-psycho-social assessment which supports referral to the ICT program.

(1) Providers of ICT must be trained in, and use, ICT as defined by the model.

(2) Providers who wish to provide ICT must undergo and pass the following provided by an entity approved by the department:

(a) a readiness assessment; and

(b) an annual fidelity review.

(3) An ICT team must have a minimum of one .125 full-time equivalent (FTE) ICT clinical supervisor and one FTE ICT clinician.

(4) One FTE ICT clinical supervisor may supervise up to eight FTE ICT clinicians.

(5) The ICT clinical supervisor must provide supervision as defined by the model, including:

(a) providing weekly one-on-one supervision; and

(b) providing weekly team case consultation to the ICT clinician who holds primary case responsibility.

(6) A clinical supervisor who is dually licensed as a licensed mental health professional and a licensed addiction counselor (LAC) must be available 24 hours a day, 7 days a week to the ICT clinicians.

(7) One FTE ICT clinician may provide services for up to six families at a time. 

(8) The following requirements must be met, as described by the ICT model by the ICT clinical supervisor, the ICT clinicians, or both:

(a) conduct an average of three hours of ICT services per week with each family through the course of treatment at the frequency, location, and duration that are sufficient to meet the identified needs of the family, unless there is a documented reason that an average of three hours of service per week cannot be met; and

(b) provide 24 hours a day, 7 days a week, face-to-face or telephonic crisis response.

(9) Treatment begins when the family consents in writing to begin services.

(1) 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 received earlier than ten days prior to the admission of the youth, will be technically denied. If a request is received after the youth has been admitted, the request will be considered from the date the request was received by the department.

(2) The clinical reviewer will complete the PA review process within two business days of receipt of complete information and take one of the following actions:

(a) request additional information as needed to complete the review and the provider must submit the requested information within five business days of the request for additional information;

(b) authorize the PA for up to 180 days as medically necessary and generate notification to all appropriate parties if the request meets the medical necessity criteria; or

(c) defer the case to a board-certified psychiatrist for review and determination if the PA request does not appear to meet the medical necessity criteria.

(3) The board-certified psychiatrist will complete the review and determination within four business days of receipt of the information from the clinical reviewer.

(4) After a denial, a new PA request may be submitted only if there is new clinical information.

(5) The following services will not be reimbursed concurrently with ICT:

(a) outpatient therapy;

(b) home-support services;

(c) community-based psychiatric rehabilitation and support;

(d) therapeutic group home;

(e) psychiatric residential treatment facility;

(f) day treatment;

(g) comprehensive school and community treatment;

(h) acute inpatient hospital services; and

(i) targeted case management.

(6) CPST services may be provided by the ICT team to a youth that is enrolled in partial hospitalization for up to 14 days.

(7) The ICT provider must provide to the family a document that explains which services cannot be reimbursed concurrently as well as the potential for repayment if such services are provided concurrently.

(8) ICT therapeutic interventions will be reimbursed as follows: procedure code H0040 at $18.73 per 15-minute unit.

(9) CPST will be reimbursed as follows: procedure code H0039 UA at $14.30 per 15-minute unit.

(1) Reimbursement for the therapeutic portion of home support services (HSS) and therapeutic foster care (TFC) services is the lesser of:

(a) the amount specified in the department's fee schedule adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(2) HSS and TFC providers must use the procedure codes designated by the department, in the fee schedule referred to in (1)(a) to be reimbursed for HSS and TFC.

(3) The TFC provider is reimbursed a daily rate. For TFC services, the department will reimburse the provider the daily rate for every day of a four-week period if the provider meets the minimum number of contacts as described in ARM 37.87.1410(6) during the four-week period.

(4) The HSS provider is reimbursed on a fee per unit of service basis. The two-hour weekly service requirement for HSS services must be met to be eligible for reimbursement. For purposes of this rule, a unit of service is based on a 15-minute unit increment. A unit of service is a period of 15 minutes as follows:

(a) one unit of service is equal to 8 minutes but fewer than 23 minutes;

(b) two units of service are greater than or equal to 23 minutes but fewer than 38 minutes;

(c) three units of service are greater than or equal to 38 minutes but fewer than 53 minutes;

(d) four units of service are greater than or equal to 53 minutes but fewer than 68 minutes;

(e) five units of service are greater than or equal to 68 minutes but fewer than 83 minutes;

(f) six units of service are greater than or equal to 83 minutes but fewer than 98 minutes;

(g) seven units of service are greater than or equal to 98 minutes but fewer than 113 minutes; and

(h) eight units of service are greater than or equal to 113 minutes but fewer than 128 minutes.

(5) HSS rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.105.

(6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of HSS or TFC treatment, including when this service is delivered in a foster home.

(1) "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 behavioral aides must have, at a minimum, a high school diploma and at least two years of experience working with emotionally disturbed youth or providing direct services in a human services field. Aides may only provide services for which they have demonstrated competency and which are not limited to the scope and practice of the licensed mental health professional.

(2) "Caregiver" means a person responsible for the well-being of the youth on a day-to-day basis with written permission from the legal representative of the youth, when applicable.

(3) "Clinical lead" means a person who is an employee of the provider agency who is responsible for the supervision and overall provision of treatment services to youth in HSS and TFC. The clinical lead must be a licensed mental health professional as defined in ARM 37.87.102 or an individual providing in-training mental health services as defined in ARM 37.87.702.

(4) "Concurrent" means any time during the 90-day period of the individualized treatment plan for HSS and TFC, unless the youth is discharged from service.

(5) "Family support specialist" (FSS) means a person who is an employee of the provider agency who provides therapeutic interventions to youth who are receiving HSS and TFC. The FSS must have a bachelor's degree in a human services field or a combination of experience and education equivalent to a bachelor's degree. For an FSS, six years of human services experience equates to a bachelor's degree, and each year of post-secondary education in human services equates to one year of experience.

(6) "Home support services (HSS)" is defined in the Manual adopted and incorporated by reference in ARM 37.87.903.

(7) "Natural supports" means relationships and supports that occur within the community in everyday life including but not limited to relationships with family members, friends, neighbors, and community acquaintances.

(8) "Therapeutic foster care (TFC)" means medically necessary, intensive in-home services delivered by a provider with specialized training and experience working with caregivers and youth in their homes, with temporary services available when a youth is homeless for fewer than 90 days. 

(1) The individualized treatment plan (ITP) must be developed in accordance with ARM 37.106.1916.

(2) The caregiver may select the members of the ITP team.

(3) Providers must inform the youth and their caregiver that Medicaid requires coordination of HSS and TFC with comprehensive school and community treatment (CSCT) planning, when applicable.

(1) 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.

(1) 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 environment through understanding the needs of the youth and the dynamics of the caregivers. TFC requires a structured, consistent, strength based therapeutic relationship between the provider and the youth and the caregiver for the purpose of treating the behavioral health needs of the youth, including improving the caregiver's ability to provide effective support for the youth and to promote healthy functioning.

(2) The following must be available and provided as clinically indicated by a mental health professional:

(a) conduct a treatment team meeting with the caregiver to develop an individualized treatment plan in accordance with ARM 37.106.1916(5);

(b) write treatment summaries at a minimum of every month describing progress and changes in the strengths and needs of the youth and the caregiver to inform service provisions; and

(c) develop a crisis plan with the caregiver that identifies a range of potential crisis situations with a range of corresponding responses including direct (face-to-face) and telephonic responses 24/7.

(3) The following services, identified in the individualized treatment plan, must be available and provided as clinically indicated:

(a) individualized therapeutic support to the youth and the caregiver based on strengths and needs;

(b) identification, coordination, and strengthening of formal and informal supports; and

(c) post-crisis consultation and crisis plan revision with the team and the caregiver, as needed.

(4) The following services must be available and provided as clinically indicated. The services must be identified in the ITP and include two of the following:

(a) skill building;

(b) assistance for the youth and the caregiver to identify resources to meet their needs;

(c) instruction for the caregiver on behavior management strategies; and

(d) psycho-educational programs.

(1) The youth may be discharged from this level of care based upon at least one the following criteria:

(a) the caregiver no longer needs this level of support or is actively using other formal and informal support networks;

(b) the treatment plan for the youth indicates the goals and objectives for the services have been substantially met;

(c) the caregiver is not engaged in the services. The lack of engagement is of such a degree that this type of support becomes ineffective or unsafe, despite documented attempts to address the engagement issues;

(d) the caregiver withdraws consent for the treatment;

(e) the youth is placed in a residential treatment setting with no plan for return to the home setting; or

(f) the youth has moved to an independent living situation and is no longer in or returning to the family setting.

(2) A discharge summary must be documented and indicate the reason for the discharge.

(1) The TFC provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19.

(2) The provider must also be a child-placing agency.

(3) A full-time clinical lead is responsible for not more than five full-time family support specialists (FSS).

(4) The clinical lead must:

(a) provide direction and consultation to the FSS to address the clinical needs of the youth and the needs of the caregiver as identified in the youth's individualized treatment plan (ITP);

(b) respond to the youth's and the caregiver's needs when the FSS is not available;

(c) orient, train, and coach the FSS; and

(d) provide one-on-one supervision at least monthly to the FSS.

(5) A full-time FSS is responsible for not more than ten youths at a time.

(6) The following requirements must be met by either the clinical lead, the FSS, or both:

(a) provide contacts at the frequency, location, and duration that are sufficient to meet the identified needs of the youth and the caregiver, with the duration of the contacts not limited;

(b) conduct a minimum of four scheduled contacts or sessions with the caregiver in each four-week period, two of which must be face-to-face within the home and community environment, excluding the provider's office or facility, based on the needs of the caregiver that are documented in the ITP;

(c) conduct a minimum of two scheduled treatment sessions with the youth, one of which must be face to face, within the home and community environment, excluding the provider's office or facility, in each four-week period, based on the needs of the youth that are documented in the ITP;

(i)  For both requirements in (b) and (c), face-to-face delivery of the treatment services is preferred. Telehealth may be substituted if clinically indicated or if the youth does not have access to face-to-face services.  Case notes must include the reason(s) for telehealth delivery of service, including documentation of attempts to identify local supports, if the need for telehealth delivery of services is related to access issues; and

(d) services provided above the minimum face-to-face contact requirements in (b) and (c) may be provided in the provider's office or facility to further meet the identified needs of the youth and the caregiver documented in the ITP. The duration of the contacts are not limited.

(7) 24/7 face-to-face and telephonic crisis response is expected.

(8) The provider of TFC must use a research-based practice curriculum to provide family-based services. Staff training in the research-based practice must be documented in the provider's personnel records. 

This rule has been repealed.

(1) Therapeutic foster care permanency (TFOC-P) services must be provided in accordance with ARM 37.87.1401 through 37.87.1408 (HSS/TFC).

(2) TFOC-P must be provided by a child placement agency in accordance with ARM Title 37, chapter 93.

(3) TFOC-P is an intensive level of treatment for youth in a therapeutic foster family placement which is permanent and includes:

(a) individual, family, and group therapies;

(b) clinical supervision provided by a licensed psychologist on a 1:20 ratio;

(c) a treatment manager who is a masters or bachelors level social worker with three years' experience, on a 1:6 ratio;

(d) behavioral aide services averaging at least ten hours per week;

(e) respite care at least one weekend per month; and

(f) additional specialized training for families.

(1) Home support services (HSS) providers must support the strengths of youth and caregivers by:

(a) identifying behavioral health abilities and needs across key areas such as school, family, social, community, and vocational environments;

(b) identifying strengths that can form the basis of the treatment plan in the areas of school, family, social, community, and vocational functioning; and

(c) prioritizing the most critical behavioral health needs and concerns as the focus of the treatment planning and delivery.

(2) HSS providers must engage in treatment planning that:

(a) clearly states the treatment goals identified in the clinical eligibility recommendation;

(b) is based on the functional assessment conducted pursuant to the manual adopted and incorporated by reference in ARM 37.87.903;

(c) is a collaborative process that involves youth and caregivers in developing a treatment plan with a manageable number of prioritized needs along with goals and strategies for addressing each need and goal;

(d) includes goals with measurable and observable outcomes;

(e) includes monthly summaries and updates every 90 days, which include outcome measurements of treatment goals; and

(f) unifies treatment plans with a targeted case manager, if applicable, and identifies all services and supports to caregivers.

(3) The provider must conduct a treatment team meeting with the caregiver to develop an individualized treatment plan in accordance with ARM 37.106.1916.

(4) The provider must measure progress on individualized treatment goals, using both the department-approved standardized assessment and treatment goal indicators to measure progress from baseline. Progress towards individualized treatment goals must be considered as part of discharge planning.

(5) The provider must collaborate and coordinate with the TCM provider, if youth and caregivers are engaged in TCM services.

(6) The provider must collaborate with youth and caregivers to identify and address suicidality, risk, and safety concerns at home, in school, and in the community to develop an individualized safety plan for each youth. Individual safety plans must be completed within 21 days of admission to HSS and must be reviewed monthly and after crisis with updates as necessary. Individual safety plans must contain the following components:

(a) delineate required safety planning and processes, youth and caregiver involvement, and plan dissemination;

(b) identification of what is considered a crisis for youth and caregivers;

(c) natural supports currently accessible to the youth and caregivers;

(d) current resources and skills accessible to the youth and caregivers;

(e) crisis escalation patterns and triggers;

(f) de-escalation strategies that are easily understood and can be implemented by the youth and caregivers;

(g) if indicated by suicidality screening, a specific plan to address suicidal thoughts or ideations;

(h) when to call the HSS team; and

(i) when to call 911.

(7) The provider must maintain requirements for crisis response as defined in ARM 37.106.1945. Individual treatment and safety plans must be immediately available to mental health center employees engaged in crisis response. 

(1) The HSS provider must be a mental health center as described in ARM Title 37, chapter 106, subchapter 19.

(2) HSS teams should consist of a family support specialist (FSS) and a clinical lead.

(3) HSS providers must ensure caseload sizes are sufficiently small to permit home support teams to respond flexibly to differing service needs of youth and families, including frequency of contact. FSS caseloads may vary between 4 to 14 families.

(4) HSS providers must provide coaching to an FSS on in-home behavioral health skills. The clinical lead shall provide feedback based on observation of practice, review of plans of care and other documentation, and progress for each youth and caregiver. The FSS must meet with their clinical lead regularly. Frequency must be at least once a week, or more frequently based on documented skills and competencies.

(5) Coaching and mentoring must be skills-based and include coaching to promote competencies in key skill sets such as safety planning, behavior management, cognitive behavioral interventions, caregivers and systemic interventions, and psychoeducation. 

This rule has been repealed.

This rule has been repealed.

(1) 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 alternative to out-of-state placement.

(1) ″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.

(2) ″Qualified provider pool″ means all in-state Medicaid providers who meet the requirements established in ARM 37.87.1604 and who are granted access to the department-approved data management system.

(1) Services funded through the program may only be provided by or through a provider that:

(a) is enrolled with the department as a Montana Medicaid provider;

(b) meets all the requirements necessary for the receipt of Medicaid monies;

(c) has been determined by the department to be qualified to provide services to youth with serious emotional disturbance in accordance with the criteria set forth in these rules and must be:

(i) a licensed mental health center;

(ii) a therapeutic group home;

(iii) a psychiatric residential treatment facility; or

(iv) a 1915(i) home and community-based state plan provider.

(d) is a legal entity; and

(e) meets all facility and other licensing requirements applicable to the services covered, the service settings provided, and the professionals employed.

(1) 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 Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(2) Department-approved acute care hospitals and the department may place treatment plans on the department-approved data management system for review by qualified providers.

(3) Upon approval for access and according to the requirements of this subchapter a qualified provider may review the treatment plans on the department-approved data management system. The qualified provider must follow all applicable department rules, policies, and procedures when proposing a plan of care for providing services in-state for at-risk youth.

(4) All services that require prior authorization must be prior authorized in accordance with ARM 37.87.903.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) 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 payment under this program.

(2) Youth referred to the CSCT program must be served in sequential order as determined by the priorities below based upon acuity and need, regardless of payer:

(a) without treatment the youth may become at risk of self-harm or harm to others;

(b) the youth requires support for transition from intensive out-of-home or community-based services;

(c) the youth is currently receiving CSCT services and is transitioning to a new school or provider;

(d) the youth meets the serious emotional disturbance criteria;

(e) the youth has not responded to positive behavior interventions and supports; or

(f) the youth is not attending school due to the mental health condition of the youth.

(1) The licensed mental health center providing a comprehensive school and community treatment (CSCT) program must have a written contract with the school district.

(2) The licensed mental health center must provide a description of the mental health services provided by the licensed mental health center during and outside of normal classroom hours.

(3) The school must identify:

(a) the provision of transportation and classroom space during nonschool days as described in ARM 37.106.1956(1)(i);

(b) the role of the school counselor and the school psychologist, as appropriate, in the provision of mental health services and supports to youth including coordination with the CSCT program;

(c) program supports, including telephone, computer access, locking file cabinet(s), and copying, that the school will make available to CSCT staff while providing services within the school;

(d) office space dedicated to CSCT which must be adequate and appropriate for confidentiality and privacy for the services provided; and

(e) treatment space available to CSCT large enough to host a group during both school and non-school days.

(4) The school and licensed mental health center must specify a referral process to the CSCT program.

(5) The school and licensed mental health center must specify an enrollment process that:

(a) includes the CSCT licensed or in-training mental health professional and a school administrator or designee;

(b) ensures youth have access to services prioritized according to acuity and need as specified in ARM 37.87.1801; and

(c) considers the current caseload of the CSCT program in terms of a wait list and near-term discharges.

(6) The school must describe the implementation of a school-wide positive behavior intervention and supports program, including, at a minimum, the following procedures:

(a) identifying youth who exhibit inappropriate behaviors to the degree that a positive behavior intervention plan is needed and youth at risk of, or suspected to have need of, mental health services;

(b) implementing and monitoring the progress of a positive behavior intervention plan for its effectiveness; and

(c) referring youth to the CSCT program when positive behavior interventions and supports have not resulted in significant positive behavioral change or when a youth may have a clinical condition and may be in need of mental health services.

(7) The school and licensed mental health center must describe annual training offered to school personnel, parents, and students concerning the following:

(a) CSCT program and services;

(b) CSCT referral process and criteria;

(c) signs and symptoms that indicate a need for mental health services for a youth; and

(d) information confidentiality and security requirements under the Family Education Rights and Privacy Act (FERPA) and Privacy and Security Rules issued under the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security, and the Health Information Technology for Economic and Clinical Health (HITECH) Act.

(8) The contract must identify program data and information which will be shared between the school district and the licensed mental health center to evaluate program effectiveness to include ARM 37.106.1956(10).

(9) The contract must identify the responsible party for each requirement specified in this rule.

(10) In the circumstance in which a school district is the licensed mental health center providing a CSCT program, the school district must adopt an operational plan that is substantially similar to the contractual requirements set forth in this rule. This operational plan must be kept on file and made available to the department upon request. 

(1) 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 number.

(2) CSCT services may be provided to:

(a) youth ages three through five who are receiving special education services from the public school in accordance with an individualized education program (IEP) under the Individuals with Disabilities Education Act (IDEA) or attending a preschool program offered through a public school; and

(b) youth ages six up to age 20, if they are enrolled in a public school.

(3) One team with up to three employees will not be reimbursed for more than 360 service days per team per month.

(a) A service day is a minimum of 30 total minutes of core services provided by the CSCT team.

(i) Core services include intake and/or annual assessment, individual therapy, family therapy, group psychotherapy or psychoeducation, behavioral interventions, crisis response during typical working hours, and care coordination.

(ii) Care coordination may only be considered a core service and be billable if two other core services are provided within that week (with a week being the period from Monday to Sunday). Care coordination includes phone calls, treatment team meetings, individualized education program (IEP) meetings, referrals, and school advocacy for youth. Care coordination does not include documentation time.

(4) Up to ten service days per youth, per state fiscal year, may be billed for an intervention, assessment, and if necessary, referral to other services. There is no limit on the number of youth that may be served. These service days must be billed as part of the 360 service days monthly team total.

(5) For a youth to qualify for more than ten service days of CSCT, a full clinical assessment is required, and the youth must meet the SED criteria identified in the Children's Mental Health Bureau Medicaid Services Provider Manual as referenced in ARM 37.87.903(7).

(6) The school district as a Medicaid provider of CSCT is subject to all Medicaid state and federal billing rules and regulations. The school district must:

(a) bill all available financial resources for support of services including third party insurance and parent payments, if applicable; and

(b) document services to support the Medicaid reimbursement received.

(7) The school district or the contracted provider must bill for youth not eligible for Medicaid. The school district may use a sliding-fee schedule.

(8) The school district must meet the match requirements through the intergovernmental transfer (IGT) process.

(9)  CSCT services rendered to youth attending school in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.106.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) 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:

(a) Supplemental Services Program;

(b) Room and Board Account;

(c) System of Care Account; and

(d) Non-Medicaid Respite Care Service.

(2) This subchapter is not intended to and does not establish an entitlement for any youth to be determined eligible for or to receive any services under the CMHB Non-Medicaid Services Program. The department may, in its discretion, limit services, rates, eligibility, and the number of youth determined eligible under the plan based upon such factors as availability of funding, the degree of financial need, the degree of medical need, and other factors.

(3) The department adopts and incorporates by reference the CMHB's Non-Medicaid Services Program Provider Manual, dated October 14, 2017 (the Manual), which sets forth the requirements and limitations of the CMHB's Non-Medicaid Services Program.

(4) The CMHB Non-Medicaid Services Program for youth with serious emotional disturbance must be delivered in accordance with the requirements and limitations of the Manual. A copy of the Manual may be obtained from the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604 or at http://dphhs.mt.gov/dsd/CMB/Manuals.aspx.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.