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(1) The department adopts and incorporates by reference the Medicaid Home and Community-Based Services for Adults With Severe Disabling Mental Illness fee schedule. A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at www.dphhs.mt.gov/amdd/services/index.shtml. A copy may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, PO Box 202905, Helena, MT 59620-2905. Reimbursement for services delivered under this subchapter will be the amounts listed in the fee schedule unless provided otherwise in this rule.

(2) The following services are reimbursed as provided in (3):

(a) homemaking;

(b) adult day health;

(c) habilitation;

(d) personal emergency response systems;

(e) nutrition;

(f) psycho-social consultation;

(g) nursing;

(h) dietetic services;

(i) specially trained attendant care;

(j) chemical dependency counseling;

(k) supported living;

(l) adult residential care;

(m) respite care not provided by a nursing facility;

(n) nonmedical transportation;

(o) specialized medical equipment and supplies;

(p) illness management and recovery services; and

(q) Wellness Recovery Action Plan (WRAP).

(3) The services specified in (2) are, except as otherwise provided in (4), reimbursed at the lower of the following:

(a) the provider’s usual and customary charge for the service; or

(b) the rate negotiated with the provider by the case management team up to the department’s maximum allowable fee.

(4) The services specified in (2) are reimbursed as provided in (3) except that reimbursement for components of those services that are incorporated by specific cross reference from the general Medicaid program may only be reimbursed in accordance with the reimbursement methodology applicable to the component service of the general Medicaid program.

(5) The following services are reimbursed in accordance with the referenced provisions governing reimbursement of those services through the general Medicaid program:

(a) personal assistance as provided at ARM 37.40.1105; and

(b) outpatient occupational therapy as provided at ARM 37.86.610.

(6) Case management services are reimbursed, as established by contractual terms, on either a per diem or hourly rate.

(7) Respite care services provided by a nursing facility are reimbursed at the rate established for the facility in accordance with ARM Title 37, chapter 40, subchapter 3.

(8) Reimbursement will not be paid for a service that is otherwise available from another source.

(9) No copayment is imposed on services provided through the program but recipients are responsible for copayment on other services reimbursed with Medicaid monies.

(10) Reimbursement is not available for the provision of services to other members of a recipient’s household or family unless specifically provided for in these rules.

History: 53-2-201, 53-6-402, MCA; IMP, 53-2-401, 53-6-402, MCA; NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2011 MAR p. 1394, Eff. 7/29/11.

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