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Rule: 37.88.101 Prev     Up     Next    
Rule Title: MEDICAID MENTAL HEALTH SERVICES FOR ADULTS, AUTHORIZATION REQUIREMENTS
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Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: MEDICAID MENTAL HEALTH SERVICES
Subchapter: General Requirements
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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37.88.101    MEDICAID MENTAL HEALTH SERVICES FOR ADULTS, AUTHORIZATION REQUIREMENTS

(1) 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 mental illness.

(2) In addition to the requirements contained in rule, the department has developed and published the Addictive and Mental Disorders Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health (Manual), dated July 1, 2020, which it adopts and incorporates by reference. The purpose of the Manual is to implement requirements for utilization management and services. A copy of the Manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at http://dphhs.mt.gov/amdd.aspx.

(3) 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(5) and 37.85.106(2)(c).

(4) 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 otherwise in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.

(5) 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 consumers.

 

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2020 MAR p. 1161, Eff. 7/1/20.


 

 
MAR Notices Effective From Effective To History Notes
37-917 7/1/2020 Current History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2020 MAR p. 1161, Eff. 7/1/20.
37-888 10/1/2019 7/1/2020 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19.
37-878 7/6/2019 10/1/2019 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19.
37-869 1/1/2019 7/6/2019 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19.
37-835 5/1/2018 1/1/2019 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15; AMD, 2018 MAR p. 725, Eff. 5/1/18.
37-724 12/25/2015 5/1/2018 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09; AMD, 2015 MAR p. 2283, Eff. 12/25/15.
37-475 8/28/2009 12/25/2015 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2009 MAR p. 1489, Eff. 8/28/09.
37-460 2/27/2009 8/28/2009 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07; AMD, 2009 MAR p. 266, Eff. 2/27/09.
8/24/2007 2/27/2009 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2007 MAR p. 1197, Eff. 8/24/07.
9/23/2005 8/24/2007 History: 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111 and 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2002 MAR p. 3423, Eff. 12/13/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2004 MAR p. 84, Eff. 1/1/04; AMD, 2004 MAR p. 1625, Eff. 6/4/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05.
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