This subchapter governs Medicaid-reimbursed mental health center services for youth with Serious Emotional Disturbance (SED) in Montana. It defines covered services including community-based psychiatric rehabilitation and support (CBPRS), youth day treatment, outpatient therapy, targeted case management, home support services, therapeutic foster care, and mental health intensive outpatient therapy (IOP), all delivered through licensed mental health centers. It also specifies noncovered services (e.g., inpatient hospital-based mental health professional services billed under DRG) and establishes reimbursement rules, including that only one fee per treatment day per youth is allowed for day treatment.
View official source37.87.702 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), DEFINITIONS For purposes of this subchapter, the following definitions apply: (1) "Community-based psychiatric rehabilitation and support (CBPRS)" means rehabilitation services provided in home, school, and community settings for youth with serious emotional disturbance (SED) who are at risk of out of home or residential placement, or risk removal from current setting for youth under six years of age. CBPRS services are provided for a short period of time, generally 90 days or less, to improve or restore the youth's functioning in one or more of the impaired areas identified in the SED definition in ARM 37.87.102 . Services are provided by trained mental health personnel under the supervision of a licensed mental health professional and according to rehabilitation goals. (2) "Comprehensive school and community treatment" is defined in the manual adopted and incorporated by reference in ARM 37.87.903 . (3) "In-training mental health professional services" refers to services provided by a candidate for licensure who: (a) has completed all academic requirements for licensure as a psychological resident (as defined in ARM 24.189.301 (8)), licensed clinical social worker, licensed professional counselor, or licensed marriage and family therapist; (b) is under the supervision of a licensed mental health professional approved by the candidate's licensing board; (c) is in the process of completing the supervised experience requirement for licensure, in accordance with ARM Title 24, chapter 189 or 219; and (d) is in the process of completing the supervised experience requirement for licensure, in accordance with ARM Title 24, chapter 189 or 219; and (4) "Licensed mental health center" is defined in ARM 37.87.102 . For purposes of this subchapter the following provisions also apply: (a) For a mental health center to be licensed, there are specific services that must be provided to its clients in accordance with ARM 37.106.1906 . (b) A mental health center may provide other appropriate services with an endorsement by the department in accordance with ARM 37.106.1906 . (5) "Mental health center services for youth with serious emotional disturbance" reimbursed by Medicaid means community-based psychiatric rehabilitation and support services, comprehensive school and community treatment programs, day treatment services, therapeutic foster care services, home support services, in-training mental health professional services, outpatient therapy services, mental health professional services, and targeted case management services. (6) "Mental health professional" is defined in ARM 37.87.102 . (7) "Outpatient therapy service" is defined in the manual adopted and incorporated by reference in ARM 37.87.903 . (8) "Serious emotional disturbance (SED)" criteria are defined in the manual adopted and incorporated by reference in ARM 37.87.903 . (9) "Treatment day" means a calendar day, including night, daytime, or evening, during which a youth receives services according to applicable requirements. (10) "Youth" is defined in ARM 37.87.102 . (11) "Youth day treatment" means a program which provides, in accordance with mental health center license requirements, an integrated set of mental health, education, and family intervention services to youth with serious emotional disturbance. Authorizing statute(s): 53-2-201 , 53-6-101 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , 53-6-111 , MCA History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2021 MAR p. 331, Eff. 3/27/21; AMD, 2024 MAR p. 2014, Eff. 8/10/24. 37.87.703 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), COVERED SERVICES (1) Mental health center services for youth with SED include: (a) Community-Based Psychiatric Rehabilitation and Support (CBPRS) services as defined in ARM 37.87.702 . (b) Comprehensive school and community treatment in accordance with ARM Title 37, chapter 87, subchapter 18. (c) Youth day treatment services as defined in ARM 37.87.702 . (d) In-training mental health professional services as defined in ARM 37.87.702 . Services are subject to the same requirements that apply to licensed mental health professionals. (e) Outpatient therapy services provided according to an individualized treatment plan and such services must include: (i) psychotherapy services provided in accordance with the current edition of the American Medical Association's Current Procedural Terminology, Professional Edition, and codes approved by the department. The department adopts and incorporates by reference this manual; (ii) family therapy, provided with or without the youth present, directed at the eligible youth's mental health needs and their impact on the family dynamics; and (iii) individual and family therapy are targeted at reducing or eliminating symptoms or behaviors related to a youth's mental health diagnosis as specified in the treatment plan. (f) Targeted case management (TCM) services as defined in the manual adopted and incorporated by reference in ARM 37.87.903 . (g) Mental health professional services, which include the professional component of physician or psychiatrist services covered in ARM 37.86.101 , 37.86.104 , and 37.86.105 . Mental health professional services are subject to the following limitations: (i) To the extent otherwise permitted by applicable Medicaid rules, such mental health professional services may be billed either by the mental health center as mental health center services or by the mental health professional under the applicable Medicaid category of service, but may not be billed as both mental health center services and mental health professional services. (ii) Mental health professional services may be covered and reimbursed by Medicaid only if the mental health professional is enrolled as a provider and the services are provided according to the Medicaid rules and requirements applicable to the mental health professional's category of service. (h) Home support services (HSS) and therapeutic foster care (TFC) as defined in the manual adopted and incorporated by reference in ARM 37.87.903 . (i) Mental health intensive outpatient therapy (IOP) as defined in the manual adopted and incorporated by reference in ARM 37.87.903 . Authorizing statute(s): 53-2-201 , 53-6-101 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , 53-6-111 , MCA History: NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2024 MAR p. 611, Eff. 3/23/24. 37.87.705 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, NONCOVERED SERVICES (1) Mental health professional services, provided in a hospital on an inpatient basis, that are covered by Medicaid as part of the diagnosis related group (DRG) payment under ARM 37.86.2907 are not reimbursable as mental health center services. These noncovered services include: (a) mental health professional services provided by mental health professionals who are staff members of a mental health center which has a contract with a hospital involving consideration; (b) services provided for purposes of discharge planning as required by 42 CFR part 482.43 ; and (c) services including but not limited to group therapy that are required as a part of hospital licensure or certification. Authorizing statute(s): 53-2-201 , 53-6-101 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , 53-6-111 , MCA History: NEW, 2009 MAR p. 272, Eff. 2/27/09. 37.87.733 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), REIMBURSEMENT (1) Medicaid reimbursement for mental health center services shall be the lesser of: (a) the provider's actual (submitted) charge for the service; or (b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.105 . (2) For day treatment services, the department will not reimburse a mental health center provider for more than one fee per treatment day per youth. This does not apply to mental health professional services to the extent such services are separately billed in accordance with these rules or targeted case management services for youth with SED. Authorizing statute(s): 53-2-201 , 53-6-101 , 53-6-113 , MCA Implementing statute(s): 53-2-201 , 53-6-101 , 53-6-111 , MCA History: NEW, 2009 MAR p. 272, 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.