37.87.1803 COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM: REIMBURSEMENT
(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.
History: 53-2-201, 53-6-113, MCA; IMP, 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2014 MAR p. 1401, Eff. 6/27/14; AMD, 2016 MAR p. 1706, Eff. 9/24/16; AMD, 2022 MAR p. 159, Eff. 1/29/22.