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37.27.107    STATE APPROVED PROGRAMS, OUTPATIENT TREATMENT PROVIDERS

(1) In order to be reimbursed for outpatient services, an outpatient treatment provider must be state approved and be a licensed addiction counselor.

(2) In order to become state approved, the outpatient provider must complete and submit the designated application to the department.

(3) If the application and supporting documentation do not meet the application requirements, the department will notify the applicant in writing identifying the incomplete or missing information within 30 days of receipt of the application.

(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.

(b) If a response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.

(4) If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely.

(5) The provider must submit the requested documentation to the department or allow the department access to the provider's premises for inspection.

(6) Within 20 days of the inspection, the department shall issue final approval or deny the application and shall send written notification of full approval or denial to the applicant.

(7) The department will reimburse a state approved outpatient treatment provider for American Society of Addiction Medicine (ASAM) level of care 1.0, Outpatient Services, using appropriate Common Procedural Terminology (CPT) codes.

(8) The department will annually inspect the provider, on-site or remotely, to ensure the provider continues to meet requirements of this rule.

(9) Approved providers must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the AMDD Medicaid Services Provider manual for SUD and Adult Mental Health located at: https://dphhs.mt.gov/amdd/policymanualmedicaid.

 

History: 53-2-201, 53-24-204, MCA; IMP, 53-24-204, 53-24-207, MCA; NEW, 2021 MAR p. 182, Eff. 2/13/21.

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