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

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

(b) for services provided to adults, the department's Medicaid fee for the service as specified in the department's Medicaid Mental Health and Mental Health Services Plan Individuals 18 Years of Age and Older Fee Schedule; or

(c) for services provided to children and adolescents, the Medicaid Mental Health and Mental Health Services Plan Individuals Under 18 Years of Age Fee Schedule adopted in ARM 37.86.2207 for services provided to youths as that term is defined at ARM 37.89.103, and a direct care wage add-on as provided in ARM 37.88.1111, if applicable.

(2) For day treatment and crisis intervention services, Medicaid will not reimburse a mental health center provider for more than one fee per treatment day per recipient. This does not apply to practitioner services to the extent such services are separately billed in accordance with these rules.

(3) Reimbursement will be made to a provider for reserving an adult foster care or mental health adult group home bed only if:

(a) the recipient's plan of care documents the medical need for a therapeutic visit as part of a therapeutic plan;

(b) the recipient is temporarily absent on a therapeutic visit;

(c) the provider clearly documents staff contact and recipient achievements or regressions during and following the therapeutic visit; and

(d) no more than 14 patient days per recipient in each rate year will be reimbursed for therapeutic visits.