This subchapter establishes Montana Medicaid (and non-Medicaid) coverage, authorization, and reimbursement standards for substance use disorder (SUD) services under the DPHHS Behavioral Health and Developmental Disabilities Division. Providers must comply with general Medicaid provider requirements, deliver services through department-approved facilities or programs, and bill using CMS HCPCS and AMA CPT codes at rates set by the department's fee schedule. The subchapter incorporates by reference both the BHDD Medicaid and Non-Medicaid SUD Provider Manuals for utilization management purposes.
View official source37.27.902 SUBSTANCE USE DISORDER SERVICES: AUTHORIZATION REQUIREMENTS (1) The purpose of rules contained in this subchapter is to establish standards for the coverage and reimbursement of substance use disorder services under the Montana Medicaid Program. (2) In addition to the requirements contained in rule, the department has developed and published the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health, dated January 1, 2025, which it adopts and incorporates by reference. The purpose of the manual is to implement requirements for utilization management and services. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities (BHDD) Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at: https://dphhs.mt.gov/bhdd/BHDDMedicaidServicesProviderManual . (3) In addition to the requirements contained in rule, the department has developed and published the BHDD Division Non-Medicaid Services Provider Manual for Substance Use Disorder, dated July 1, 2025, which it adopts and incorporates by reference. The purpose of the manual is to implement requirements for utilization management and services. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities (BHDD) Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena MT 59620-2905 or at: https://dphhs.mt.gov/bhdd/BHDDNonMedicaidServicesProviderManual . Authorizing statute(s): 53-6-113 , 53-24-204 , 53-24-208 , 53-24-209 , MCA Implementing statute(s): 53-6-101 , 53-24-204 , 53-24-208 , 53-24-209 , MCA History: NEW, 2017 MAR p. 2081, Eff. 11/10/17; AMD, 2018 MAR p. 725, Eff. 5/1/18; AMD, 2018 MAR p. 2409, Eff. 1/1/19; AMD, 2019 MAR p. 1061, Eff. 7/6/19; AMD, 2019 MAR p. 1640, Eff. 10/1/19; AMD, 2020 MAR p. 1161, Eff. 7/1/20; AMD, 2020 MAR p. 1740, Eff. 10/1/20; AMD, 2021 MAR p. 331, Eff. 3/27/21; AMD, 2022 MAR p. 1889, Eff. 9/24/22; AMD, 2023 MAR p. 1890, Eff. 12/23/23; AMD, 2024 MAR p. 729, Eff. 4/13/24; AMD, 2024 MAR p. 2014, Eff. 8/10/24; AMD, 2025 MAR, Notice No. 37-1104, Eff. 3/8/25; AMD, 2025 MAR, Notice No. 37-1110, Eff. 6/7/25; AMD, 2026 MAR, Notice No. 2025-152, Eff. 1/10/26. 37.27.903 MEDICAID SUBSTANCE USE DISORDER SERVICES: GENERAL REQUIREMENTS (1) General Medicaid provider requirements found in ARM 37.85.104 through 37.85.1125 are applicable to all Medicaid substance use disorder services. (2) HELP Medicaid requirements found in ARM 37.84.101 through ARM 37.84.115 are applicable to all Medicaid substance use disorder services. (3) All services must be delivered by facilities or programs approved by the department. Authorizing statute(s): 53-6-113 , 53-24-204 , 53-24-208 , 53-24-209 , MCA Implementing statute(s): 53-6-101 , 53-24-204 , 53-24-208 , 53-24-209 , MCA History: NEW, 2017 MAR p. 2081, Eff. 11/10/17; AMD, 2018 MAR p. 725, Eff. 5/1/18. 37.27.905 MEDICAID SUBSTANCE USE DISORDER SERVICES: REIMBURSEMENT (1) Medicaid substance use disorder programs must bill for services using procedure codes, modifiers, and definitions contained in the: (a) Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Code System (HCPCS); and (b) American Medical Association's (AMA) Current Procedural Terminology (CPT) Codes. (2) Subject to requirements of this rule, the Medicaid substance use disorder program pays the lower of the following for Medicaid eligible members: (a) the Medicaid substance use disorder program's usual and customary charge for services; (b) the reimbursement methodologies described in ARM 37.85.212 ; or (c) for items or services where no Resource Based Relative Value (RBRVS) or Medicare fee is available, the department's fee schedule. (3) The allowable Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.105 . (4) The allowable non-Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.104 . (5) The allowable Medicaid substance use disorder reimbursement rate for case management services for members with substance use disorder is stated in the department's fee schedule provided in ARM 37.85.106 . Authorizing statute(s): 53-6-113 , 53-24-204 , 53-24-208 , 53-24-209 , MCA Implementing statute(s): 53-6-101 , 53-24-204 , 53-24-208 , 53-24-209 , MCA History: NEW, 2017 MAR p. 2081, Eff. 11/10/17; AMD, 2018 MAR p. 458, Eff. 3/1/18.