37.86.3006    MENTAL HEALTH OUTPATIENT PARTIAL HOSPITAL SERVICES, REQUIREMENTS

(1) Medicaid reimbursement is not available for outpatient partial hospitalization services unless:

(a) the person is experiencing psychiatric symptoms of sufficient severity to create severe impairments in educational, social, vocational, or interpersonal functioning;

(b) the person cannot be safely and appropriately treated in a less restrictive level of care;

(c) proper treatment of the person's psychiatric condition requires acute treatment services on an outpatient basis under the direction of a physician; and

(d) the services can reasonably be expected to improve the person's condition or prevent further regression.

(2) Partial hospitalization services may include day, evening, night, and weekend treatment programs that must employ an integrated, comprehensive, and complementary schedule of recognized treatment or therapeutic activities.

(3) Acute level partial hospitalization is provided by programs which:

(a) are operated by a hospital as defined in 50-5-101, MCA, and are collocated with that hospital such that in an emergency a patient of the acute partial hospitalization program can be transported to the hospital′s inpatient psychiatric unit within 15 minutes;

(b) serve primarily persons being discharged from inpatient psychiatric treatment or inpatient psychiatric residential treatment; and

(c) provide psychotherapy services consisting of at least individual, family, and group sessions at a frequency designed to stabilize the person sufficiently to allow discharge to a less intensive level of care at the earliest appropriate opportunity.

(4) Acute level partial hospitalization is reimbursed according to ARM 37.86.3022.

(5) Subacute partial hospitalization is provided for in ARM 37.87.903(8).

(6) Prior authorization is not a guarantee of payment.

History: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2014 MAR p. 2147, Eff. 9/19/14.