(1) The therapeutic and rehabilitative portion of medically necessary therapeutic foster care permanency (TFOC-P) services is covered if prior-authorized by the department or its designee according to the provisions of the Children's Mental Health Bureau's (CMHB) Provider Manual and Clinical Guidelines for Utilization Management incorporated in ARM 37.87.903 and this subchapter. TFOC-P providers are required to abide by the CMHB Provider Manual and Clinical Guidelines for Utilization Management.

(2) Medicaid reimbursement is not available for TFOC-P services unless the provider submits to the department or its designee in accordance with this subchapter and the CMHB Provider Manual and Clinical Guidelines for Utilization Management, a complete and accurate CON that certifies the level of care needed for the youth with a serious emotional disturbance (SED).

(3) For youth determined Medicaid eligible by the department at the time of admission to TFOC-P services, the CON required under (2) must be:

(a) completed, signed, and dated prior to, but no more than 30 days before, admission; and

(b) written by a team of health care professionals that has competence in diagnosis and treatment of mental illness, and that has knowledge of the youth's situation, including the youth's psychiatric condition. The team must include a physician that has competence in diagnosis and treatment of mental illness, preferably in child psychiatry, and a licensed mental health professional as defined in ARM 37.87.102.

(4) All CONs required under (2) must actually and personally be signed by a minimum of two team members. Two of the signatures must be:

(a) a physician who has competence in diagnosis and treatment of mental illness, preferably child psychiatry, or a board-certified/board-eligible psychiatrist; and

(b) a licensed mental health professional. If a signature stamp is used, the team member must actually and personally initial the document over the signature stamp.

(5) The therapeutic portion of TFOC-P services, as defined by ARM 37.87.1407, is covered if provided by a TFOC-P agency licensed by and contracted with the department to provide TFOC-P services.

(6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of TFOC-P treatment, including when this service is delivered in a foster home.

(7) Targeted case management will not be reimbursed concurrent with TFOC-P.