ARM 37.27.2

ARM 37.27.2 Room and Board Voucher Program

This subchapter establishes the Montana Substance Use Disorder Voucher Program, which covers room and board costs for individuals receiving ASAM 3.1 (clinically managed low-intensity residential) substance use disorder treatment that are not covered by insurance or other assistance programs. To qualify, individuals must be Montana residents aged 14 or older, have family income at or below 200% of the federal poverty level, meet medical necessity criteria, and have prior authorization for ASAM 3.1 services. Facilities seeking reimbursement must be state-approved substance use disorder programs licensed as ASAM 3.1 facilities and must submit a designated request form to the department for approval.

37.27.201
 SUBSTANCE USE DISORDER VOUCHER PROGRAM, PURPOSE 

(1)
 
The purpose of the rules in this subchapter is to establish standards for the Substance Use Disorder Voucher Program, as provided in Title 53, chapter 24, part 2, MCA. 

(2)
 
This program is intended to cover the cost of substance use disorder treatment room and board that is not otherwise covered by insurance or another assistance program. 

(3)
 
This program is subject to available funding. 

Authorizing statute(s):
 
53-24-204
, MCA

Implementing statute(s):
 
53-24-218
, MCA

History: 
NEW, 2024 MAR p. 967, Eff. 4/27/24.

37.27.202
 SUBSTANCE USE DISORDER VOUCHER PROGRAM, DEFINITIONS 

In addition to the terms defined in 
53-24-103
, MCA, the following definitions shall apply in the interpretation and enforcement of the rules in this subchapter:

(1)
 
"American Society of Addiction Medicine (ASAM) Criteria" means guidelines for placement, continued stay, and transfer, or discharge of individuals with addiction and co-occurring conditions developed by the American Society of Addiction Medicine. 

(2)
 
"ASAM 3.1" means substance use disorder clinically managed low-intensity residential treatment services for adults or adolescents, which is a level of care described in the ASAM Criteria. 
 
ASAM 3.1 is a licensed community-based residential facility that functions as a supportive, structured living environment. 
 
Individuals are provided stability and skills building to help prevent or minimize continued substance use. 
 
This level of care includes a minimum of five hours per week of professionally directed treatment services. 

(3)
 
"BHDD Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health adopted and incorporated by reference in ARM 
37.27.902
. 
 
The manual can be found at: 
https://dphhs.mt.gov/BHDD/BHDDMedicaidServicesProviderManual 
. 

(4)
 
"Substance use disorder" means chemical dependency, as defined in 
53-24-103
, MCA. 

Authorizing statute(s):
 
53-24-204
, MCA

Implementing statute(s):
 
53-24-218
, MCA

History: 
NEW, 2024 MAR p. 967, Eff. 4/27/24.

37.27.203
 SUBSTANCE USE DISORDER VOUCHER PROGRAM, REQUIREMENTS 

(1)
 
In order to participate in the substance use disorder voucher program, an individual must: 

(a)
 
live in Montana; 

(b)
 
be 14 years of age or older; 

(c)
 
have an annual family income at or below 200% of federal poverty guidelines; 

(d)
 
meet medical necessity described in the BHDD Medicaid Manual for ASAM 3.1 services; 

(e)
 
receive a prior authorization for ASAM 3.1 services from the Quality Improvement Organization (QIO); and 

(f)
 
currently be receiving ASAM 3.1 services. 

Authorizing statute(s):
 
53-24-204
, MCA

Implementing statute(s):
 
53-24-218
, MCA

History: 
NEW, 2024 MAR p. 967, Eff. 4/27/24.

37.27.204
 SUBSTANCE USE DISORDER VOUCHER PROGRAM, REIMBURSEMENT 

(1)
 
In order to be reimbursed for room and board under the Substance Use Disorder Voucher Program in
 
ARM 
37.27.201
, a program must be a state-approved substance use disorder facility under ARM 
37.27.106
 and licensed as an ASAM 3.1 substance use disorder facility pursuant to ARM Title 37, chapter 106, subchapter 14. 

(2)
 
A provider that meets requirements in
 
ARM 
37.27.203
 
and seeks reimbursement for room and board under the Substance Use Disorder Voucher Program must complete and submit the designated request form to the department to obtain reimbursement for such services provided to a qualified individual. 

(3)
 
The department will review the request and provide approval or denial to the provider within 10 working days of receipt of the request. 

(4)
 
If the request is approved, the department will issue payment to the provider. 

(5)
 
The department will reimburse providers as outlined in contract or policy. 

Authorizing statute(s):
 
53-24-204
, MCA

Implementing statute(s):
 
53-24-218
, MCA

History: 
NEW, 2024 MAR p. 967, Eff. 4/27/24.