(1) Mental health center services for youth with serious emotional disturbance include:

(a) Community-based psychiatric rehabilitation and support services:

(i) are provided on a face-to-face basis primarily with a youth, or on a face-to-face basis with family members, teachers, employers, or other key individuals in the youth's life when such contacts are clearly necessary to meet goals established in the youth's individual rehabilitation treatment plan;

(ii) have as their purpose:

(A) the maximum attainment of mental functioning;

(B) the minimization or elimination of deterioration in mental functional status; and

(C) the maintenance of mental health functional status of a youth.

(iii) must be prior authorized by the department or its designee to be provided in comprehensive school and community treatment programs, day treatment, partial hospitalization, therapeutic group home facilities, therapeutic foster homes, therapeutic family homes, or other residential facilities in accordance with all of the following:

(A) youth with extraordinary behavioral needs whose behaviors have not resulted in criminal or status offenses may be eligible for community-based psychiatric rehabilitation and support;

(B) proposed services must be reviewed on a case-by-case basis by the department or its designee to determine the medical necessity and number of units authorized as defined in (1)(a)(ii); and

(C) sufficient documentation supporting the medical necessity for the additional services must be provided by the requestor.

(iv) excludes the following services except as provided in (1)(a)(iii):

(A) interventions provided in a hospital, skilled nursing facility, intermediate nursing facility, or psychiatric residential treatment facility;

(B) case planning activities, including but not limited to, attending meetings, completing paperwork and other documentation requirements, and traveling to and from the youth's home, or other location;

(C) therapeutic interventions by licensed mental health professionals, regardless of the location of the service;

(D) activities that are purely recreational in nature;

(E) services provided within the school classroom that are educational, including but not limited to educational aides;

(F) habilitation services; and

(G) services within day treatment, therapeutic group home, therapeutic foster home, therapeutic family home, or other residential facilities solely for the purpose of staff safety.

(b) Comprehensive school and community treatment in accordance with ARM 37.86.2224.

(c) Youth day treatment services as defined in ARM 37.87.702.

(d) In-training mental health professional services as defined in ARM 37.87.702. Such services must be supervised by a licensed mental health professional in the same field, and, other than licensure, the services are subject to the same requirements that apply to licensed mental health professionals.

(e) Outpatient therapy services such as:

(i) psychotherapy and related services provided by a mental health professional acting within the scope of the professional's license; and

(ii) family therapy, if medically necessary for the treatment of the Medicaid eligible youth who is involved in the family therapy:

(A) family therapy may be provided with or without the Medicaid eligible youth present;

(B) adequate documentation must be present to document the direct benefit to the Medicaid eligible youth in accordance with the treatment plan;

(C) individual and family therapy are targeted at reducing or eliminating symptoms or behaviors related to a youth's mental health diagnosis as specified in the treatment plan;

(D) the mental health professional is required to develop and implement a treatment plan for the youth and family; and

(E) individual therapy includes diagnostic interviews where testing instruments are not used.

(f) Targeted case management services in accordance with Title 37, chapter 86, subchapter 37.

(g) Mental health professional services provided according to mental health center licensing requirements as part of mental health center services.

(i) To the extent otherwise permitted by applicable Medicaid rules, such mental health professional services may be billed by the mental health center either as mental health center services or by the mental health professional under the applicable Medicaid category of service, but may not be billed as both mental health center services and mental health professional services.

(ii) Mental health professional services may be covered and reimbursed by Medicaid only if the mental health professional is enrolled as a provider and the services are provided according to the Medicaid rules and requirements applicable to the mental health professional's category of service and within the scope of practice, including but not limited to medication management.

(iii) Mental health center services covered by the Medicaid program include the medical director component of a physician's services to a mental health center, but do not include the professional component of physician services covered in ARM 37.86.101, 37.86.104, and 37.86.105. The professional component of physician services may be billed according to the provisions of (1)(g)(i) or ARM 37.86.101, 37.86.104, and 37.86.105.