(1) Medically necessary mental health services for a youth with SED who meets financial criteria are covered under the plan for enrolled youth, except as provided in this subchapter.

(2) Covered services include:

(a) evaluation and assessment of psychiatric conditions by licensed and enrolled mental health providers;

(b) primary care providers, as defined in ARM 37.86.5001, for screening and identifying psychiatric conditions and for medication management;

(c) a psychotropic drug formulary, as specified in (4);

(d) medication management, including lab services necessary for management of prescribed medications medically necessary with respect to a covered diagnosis; and

(e) treatment planning, individual, group, and family therapy, and consultations performed by licensed psychologists, licensed clinical social workers, and licensed professional counselors for treatment of covered diagnoses in private practice or in mental health centers.

(3) Coverage of medically necessary mental health services for a covered diagnosis will not be denied solely because the member also has a noncovered diagnosis.

(4) The plan covers the medically necessary psychotropic medications listed in the department's Mental Health Services Plan drug formulary if medically necessary with respect to a covered diagnosis. The department may revise the formulary from time to time. A copy of the current formulary may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 555 Fuller, P.O. Box 202905, Helena, MT 59620-2905.

(5) The MHS plan covers medically necessary mental health services for any covered diagnosis for a member with a primary diagnosis of mental retardation or developmental disability, but does not cover treatment, habilitation, or other services required by the member's mental retardation or developmental disability.

(6) The MHS plan does not cover:

(a) inpatient or emergency hospital services;

(b) inpatient psychiatric residential treatment services;

(c) any form of transportation services; and

(d) detoxification, drug or alcohol evaluation, treatment, or rehabilitation, regardless of the member's diagnosis.

(7) A youth who is in a correctional or detention facility is not entitled to services under the plan, except as specifically provided in these rules.

(a) The plan covers discharge planning services in relation to a covered diagnosis prior to release from a correctional or detention facility for a youth who is:

(i) within 60 days of release;

(ii) a youth under the custody of the department's division of child and family services or the Department of Corrections and who is in a correctional or detention facility;

(iii) being held in a juvenile correction facility.

(b) A youth incarcerated in a local government criminal detention facility who has not been adjudicated may receive medically necessary mental health services for covered diagnosis during incarceration, except that the plan does not cover the youth's security or detention needs.

(c) A youth may receive medically necessary mental health services for covered diagnoses after leaving the correctional or detention facility, except that the plan does not cover the youth's security or detention needs.