37.87.809 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, REIMBURSEMENT
(1) Targeted case management (TCM) services for youth with SED will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is based on a 15-minute unit increment:
(a) one unit of service is equal to 8 minutes but less than 23 minutes;
(b) two units of service are greater than or equal to 23 minutes but less than 38 minutes;
(c) three units of service are greater than or equal to 38 minutes but less than 53 minutes;
(d) four units of service are greater than or equal to 53 minutes but less than 68 minutes;
(e) five units of service are greater than or equal to 68 minutes but less than 83 minutes;
(f) six units of service are greater than or equal to 83 minutes but less than 98 minutes;
(g) seven units of service are greater than or equal to 98 minutes but less than 113 minutes; and
(h) eight units of service are greater than or equal to 113 minutes but less than 128 minutes.
(2) Targeted case management services rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.106.
(3) The department will pay providers of targeted case management services for youth with SED the lesser of:
(a) the provider's actual submitted charge for services; or
(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.106.
(4) Case managers may not bill for time spent writing progress notes. This activity is included in the rate for TCM services.
(5) TCM services may be billed whether provided face-to-face or by telephone.
History: 53-2-201, 53-6-113, MCA; IMP, 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2012 MAR p. 1273, Eff. 7/1/12; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2016 MAR p. 2063, Eff. 11/11/16; AMD, 2020 MAR p. 691, Eff. 11/1/20.