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37.79.316    MENTAL HEALTH BENEFITS

(1) Mental health benefits include:

(a) inpatient services furnished by public or private licensed and qualified practitioners in a hospital, including a state-operated mental hospital, a residential service, or a partial hospitalization program; and

(b) outpatient services furnished by public or private licensed and qualified practitioners in a community based setting or in a mental hospital.

(2) Mental health benefits are limited to:

(a) 21 days of inpatient mental health care per benefit year;

(b) partial hospitalization benefits which are exchanged for inpatient days at a rate of two partial treatment days for one inpatient day; and

(c) 20 outpatient visits per year which can be furnished in community based settings or in a mental hospital.

(3) Mental health benefits will not be limited for enrollees with the following disorders:

(a) schizophrenia;

(b) schizoaffective disorder;

(c) bipolar disorder;

(d) major depression;

(e) panic disorder;

(f) obsessive-compulsive disorder; and

(g) autism.

(4) Additional mental health benefits are available for children with a serious emotional disturbance. These additional services are limited and may include:

(a) additional therapeutic group home care, including room and board;

(b) additional office visits for enrollee and/or family;

(c) therapeutic family care (moderate level);

(d) day treatment;

(e) community based psychiatric rehabilitation and support; and

(f) respite care.

(5) Mental health benefits shall be provided at least to the extent required by state law.

History: 53-4-1009, MCA; IMP, 53-4-1003, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 1027, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08.

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