(1) Inpatient free standing treatment is limited to persons 20 years of age or younger with a diagnosis of substance dependency utilizing the diagnostic standards published in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994) (DSM-IV) , which is hereby adopted and incorporated by reference. Copies of applicable portions of the DSM-IV may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 555 Fuller, P.O. Box 202905, Helena, MT 59620-2905.

(2) All inpatient free standing treatment must have prior written approval of the utilization reviewer.

(a) A provider of substance dependency treatment services must submit a referral to the utilization reviewer before providing inpatient free standing treatment.

(b) A referral for inpatient free standing treatment must be in the form specified by the department. Referral forms may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 555 Fuller, P.O. Box 202905, Helena, MT 59620-2905.

(3) Medicaid inpatient free standing treatment services are available to youth who have a diagnosis of substance dependency.