(1) For inpatient psychiatric services provided in a PRTF on or after December 31, 2013, for youth as defined in ARM 37.87.102, the Montana Medicaid Program will pay a PRTF for each patient day as provided in these rules.

(a) Medicaid payment is not allowable for treatment or services provided in a PRTF that are not consistent with the definition of PRTF in ARM 37.87.1202 and unless all other applicable requirements are met.

(2) For in-state PRTFs, the Montana Medicaid Program will pay a provider, for each Medicaid patient day, a bundled per diem rate as specified in (3), less any third party or other payments. Services included in the bundled per diem rate are defined in (5).

(3) The bundled per diem rate for in-state PRTF services is the lesser of:

(a) the amount specified in the department's Medicaid Youth Mental Health fee schedule, as adopted in ARM 37.85.105; or

(b) the provider's usual and customary charges.

(4) Out-of-state PRTFs will be reimbursed 50% of their usual and customary charges. Services that must be included in the out-of-state PRTFs usual and customary rate are outlined in (7).

(5) The bundled per diem rate for in-state PRTFs coverage includes the following services:

(a) a direct-care wage add-on through a contract with the department or in the bundled per diem rate, as applicable; effective July 1, 2013;

(b) services, therapies, and items related to treating the psychiatric condition of the youth;

(c) services provided by licensed psychologists, licensed clinical social workers, and licensed professional counselors;

(d) psychological testing;

(e) lab and pharmacy services related to treating the psychiatric condition of the youth; and

(f) supportive services necessary for daily living and safety.

(6) The bundled per diem rate for in-state PRTFs does not include the following services, which are separately reimbursable by the Medicaid program for enrolled providers:

(a) licensed physician, psychiatrist, and midlevel practitioner services;

(b) non-psychotropic medication and related lab services;

(c) adult mental health center evaluations for transition age youth 17 to 18, to determine whether or not they qualify for adult mental health services and have a severe and disabling mental illness; and

(d) Medicaid state plan ancillary services, except targeted case management provided by the PRTF or by outside providers, if they are:

(i) in the plan of care for the youth;

(ii) provided under the direction of the PRTF physician; and

(iii) provided under an arrangement with other qualified providers.

(7) The bundled per diem rate for out-of-state PRTFs coverage includes the following services:

(a) all services, therapies, and items related to treating the condition of the youth;

(b) licensed physician, psychiatrist, and midlevel practitioner, psychologist, clinical social worker, and professional counselor services;

(c) psychological testing;

(d) lab and pharmacy services; and

(e) supportive services necessary for daily living and safety.

(8) The bundled per diem rate for out-of-state PRTFs does not include the following services, which are separately reimbursable by the Medicaid program for enrolled providers:

(a) up to 80 units of targeted case management services as defined in ARM 37.87.802 per PRTF stay;

(b) a clinical intake assessment by a licensed mental health center, with an endorsement to provide adult services, for transition age youth 17 to 18, to determine whether or not they have a severe and disabling mental illness and if they qualify for adult mental health services; and

(c) Medicaid state plan ancillary services, provided by the PRTF or by outside providers, if they are:

(i) in the plan of care for the youth;

(ii) provided under the direction of the PRTF physician; and

(iii) provided under an arrangement with other qualified providers.

(9) The PRTF must maintain the medical records for Medicaid state plan ancillary services the youth receives.

(10) Reimbursement will be made to in-state and out-of-state PRTF providers for reserving a bed while the youth is temporarily absent for a therapeutic home visit if:

(a) the plan of care for the youth documents the medical need for therapeutic home visits as part of a therapeutic plan to transition the youth to a less restrictive level of care;

(b) the provider clearly documents staff contact and youth achievements or regressions during and following the therapeutic home visit;

(c) the youth is absent from the provider's facility for no more than three patient days per therapeutic home visit, unless additional days are authorized by the department; and

(d) the out-of-state PRTF pays for transportation for youth on a therapeutic home visit from an out-of-state PRTF.

(11) No more than 14 patient days per youth in each state fiscal year will be reimbursed for therapeutic home visits.

(12) Providers must bill for PRTF services using the revenue codes designated by the department.

(13) Notice of the admission and discharge dates for the youth must be submitted to the department or its designee the day of admission or discharge. The department may impose a $100 charge against the facility for each instance where the department does not receive timely notification.