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(1) The Montana Medicaid Program will reimburse providers of inpatient psychiatric services provided to a youth in a psychiatric residential treatment facility (PRTF) for each patient day, which is consistent with the definition of a PRTF and all other applicable requirements are met.

(2) The Montana Medicaid Program will pay a provider for each Medicaid patient day, the following bundled per diem rate less any third party or other payments. 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.

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

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

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

(c) psychological testing;

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

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

(4) A direct-care wage add-on is reimbursed in addition to the in-state per diem through a contract with the department or in the bundled per diem rate, as applicable.

(5) The Montana Medicaid Program will reimburse enrolled providers directly for the following services which are not included in the in-state per diem rate:

(a) services provided by a licensed physician, psychiatrist, or midlevel practitioner;

(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) up to 60 consecutive days of targeted case management services for the purpose of planning the youth's transition to the community. A youth should retain the case manager the youth had prior to entry into PRTF services, if applicable. If the youth is assigned a case manager who is different from the one previous to PRTF services, the case manager must document the rationale for the change.

(6) The Montana Medicaid Program will reimburse state plan ancillary services in addition to the in-state PRTF bundled per diem rate when these ancillary services are provided by a PRTF or by a different provider under arrangement with the PRTF. The ancillary services provided must be:

(a) directed by a PRTF physician;

(b) stated in the treatment plan of the youth; and

(c) maintained in the medical records for the youth. 


History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2009 MAR p. 418, Eff. 4/17/09; AMD, 2009 MAR p. 2486, Eff. 1/1/10; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2013 MAR p. 270, Eff. 3/1/13; AMD, 2013 MAR p. 2433, Eff. 12/31/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 2147, Eff. 12/11/15; AMD, 2020 MAR p. 691, Eff. 11/1/20.

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