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(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) For purposes of Medicaid coverage and reimbursement, licensed social work services are limited to the services designated in the department's Covered Social Work CPT Codes List (2004). The department adopts and incorporates by reference the Covered Social Work CPT Codes List (2004). A copy of the Covered Social Work CPT Codes List (2004) 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) Group therapy services provided by licensed clinical social worker must have no more than eight individuals participating in the group.

(4) When an eligible child receives licensed clinical social worker services and the provider consults with the parent as part of the child's treatment, the time with the parent may be billed to Medicaid under the child's name, subject to the requirements of these rules. The provider shall indicate on the claim that the child is the patient and state the child's diagnosis. He shall also indicate consultation was with the parent.

(5) Licensed clinical social worker services must be supported by records as required in ARM 37.85.414.

(6) Services provided through interactive video systems are considered to be face-to-face services and are covered and reimbursed in the same fashion as in-person services. Telephone contacts are not a licensed clinical social worker service.

(7) Services that can be included under a facility's long term care per diem are not payable as licensed clinical social work services.

(8) Inpatient social work services provided in a hospital on an inpatient basis that are covered by Medicaid as part of the diagnosis related group (DRG) payment under ARM 37.86.2907 are not reimbursable as licensed clinical social worker services. These noncovered services include:

(a) services provided by a licensed clinical social worker who is employed or under a contract with a hospital;

(b) services provided for purposes of discharge planning as required by 42 CFR, part 482.43; and

(c) services, including, but not limited to, group therapy, that are required as part of hospital licensure or certification.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2004 MAR p. 482, Eff. 2/27/04.

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