(1) Payment for psychiatric residential treatment facility (PRTF) services provided outside the state of Montana will be made only under the conditions specified in this rule and subchapter. The Montana Medicaid program will not make payment for PRTF services provided by out-of-state facilities unless the department or its designee determines that PRTF, and applicable PRTF waiver services in the state of Montana are unavailable. PRTF waiver sites are identified in ARM 37.87.1303.

(2) PRTF and PRTF waiver services in the state of Montana will be determined unavailable when:

(a) the youth has been officially screened for admission by all enrolled in-state PRTFs, and an applicable PRTF waiver site, and denied admission because the PRTFs or PRTF waiver site cannot meet the youth's treatment needs; or

(b) the youth has been officially screened for admission by all enrolled in-state PRTFs, and an applicable PRTF waiver site, and denied admission for one of the following reasons:

(i) a bed or opening is not available in a PRTF or PRTF waiver site; or

(ii) the youth's parent or legal guardian refuses PRTF waiver services; or

(iii) the youth's psychiatric condition prevents the youth from being temporarily and safely placed in another setting while awaiting admission to an in-state PRTF or PRTF waiver site.

(3) The department or its designee will not commence a preadmission review for or certify an admission to an out-of-state PRTF until receiving from the prospective PRTF written verification that the youth cannot be served within the state of Montana.

(a) Written verification must be provided on a form approved by the department or its designee, and must be completed and signed on behalf of the in-state PRTFs and an applicable PRTF waiver site indicating that the requirements of (2)(a) or (2)(b) are met.

(b) In-state PRTFs and a PRTF waiver site that do not complete, sign, and return the form by fax to the prospective out-of-state PRTF within three days after receipt will be deemed to be unable to serve the youth.