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(1) Case management services for adults with severe disabling mental illness will be reimbursed on a fee per unit of service basis as follows. For purposes of this rule, a unit of service is a period of 15 minutes.

(2) The department adopts the method of establishing rates for mental health case manager providers approved by the Centers for Medicare and Medicaid Services (CMS) on February 1, 2011. That method is:

(a) The department determined the total costs of providing case management services by using case management provider reports of the most recent wage costs, benefit costs, and other case management costs.

(b) The department used actual time units billed from the providers of the most complete fiscal year.

(c) The department determined yearly wage cost per case manager full-time employee (FTE) added to the yearly benefit costs per case manager FTE, and yearly other costs per FTE. The total costs are divided by the average units billed per FTE. This final calculation will be the rate per 15-minute unit.

(d) The department will update the rate setting methodology every three years or whenever significant changes in services occur.

(3) The department adopts and incorporates by reference the department's fee schedule dated August 1, 2011 which sets forth the reimbursement rates for case management. A copy of the fee schedule is posted at the Montana Medicaid provider web site at www.dphhs.mt.gov/amdd/services/index.shmtl. A copy of the department's fee schedule may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, PO Box 202905, Helena, MT 59620-2905.

(4) The department may, in its discretion, designate a single provider of case management services in a designated geographical region. Any provider designated as the sole case management provider for a designated geographical region must, as a condition of such designation, agree to serve the entire designated geographical region.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; EMERG, AMD, 2003 MAR p. 1087, Eff. 5/23/03; AMD, 2010 MAR p. 424, Eff. 2/12/10; AMD, 2011 MAR p. 449, Eff. 3/25/11; AMD, 2011 MAR p. 1394, Eff. 7/29/11.

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