(1) Payment for inpatient psychiatric services provided outside the state of Montana will be made only under the conditions specified in ARM 37.85.207(3) and these rules. The Montana Medicaid program will not make payment according to ARM 37.85.207(3) (b) or (c) for inpatient psychiatric services provided by residential treatment facilities located outside the state of Montana unless the department or its designee determines, as provided in this rule, that the services were unavailable in the state of Montana.

(2) Residential psychiatric care will not be determined to be unavailable in the state of Montana unless:

(a) the recipient has been officially screened for placement by all enrolled in-state residential treatment facility providers and denied admission because the facilities cannot meet the recipient's treatment needs; or

(b) the recipient has been officially screened for placement by all enrolled in-state residential treatment facility providers and denied admission because a bed is not available, and the recipient's psychiatric condition prevents the recipient from being temporarily and safely placed in another setting while awaiting placement in an in-state residential treatment facility.

(3) The department or its designee will not commence a preadmission review for or certify an admission to an out-of-state residential treatment facility until receiving from the prospective facility written verification that the recipient cannot be served within the state of Montana. Written verification must be provided in a form approved by the department or its designee, and must be completed and signed on behalf of in-state facilities indicating that the requirements of (2) (a) or (2) (b) are met. In-state facilities that do not complete, sign and return the form by fax to the prospective out-of-state provider within three days after receipt will be deemed to be unable to serve the recipient.