ARM 37.87.10

ARM 37.87.10 Therapeutic Group Home

This regulation establishes Medicaid provider requirements and reimbursement rules for Therapeutic Group Home (TGH) services in Montana. Providers must be licensed as a TGH under state statute and applicable ARM rules, maintain individualized treatment plans and required clinical records, and bill using department-designated procedure codes. Reimbursement is paid at a daily patient-day rate for therapeutic and rehabilitative services only; room, board, and non-therapeutic components are not covered by Medicaid.

37.87.1011
 THERAPEUTIC GROUP HOME (TGH), PROVIDER REQUIREMENTS 

(1)
 
The requirements in this subchapter are in addition to those requirements contained in rules generally applicable to Medicaid providers. 

(2)
 
Therapeutic group home (TGH) services may be provided
 
by
 
an in-state
 
facility which is licensed as a TGH by the department in accordance with the provisions of Title 52, chapter 2, part 6, MCA, and found in ARM 
37.87.1011
, 
37.87.1017
, and the manual adopted and incorporated by reference in ARM 
37.87.903
, or by an out-of-state facility similarly licensed in the state in which it operates. 

(3)
 
TGH services must be provided to a youth in accordance with an individualized treatment plan developed and maintained as specified by licensure requirements and this subchapter. 

(4)
 
In addition to the clinical records required by TGH licensure rules, the provider must maintain the records required by ARM 
37.85.414
. 

Authorizing statute(s):
 
53-2-201
, 
53-6-113
, MCA

Implementing statute(s):
 
53-2-201
, 
53-6-101
, 
53-6-111
, MCA

History: 
NEW, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2024 MAR p. 611, Eff. 3/23/24.

37.87.1013
 THERAPEUTIC GROUP HOME (TGH), REIMBURSEMENT 

(1)
 
For the purpose of this subchapter, the following definitions apply: 

(a)
 
"Patient day" means a whole 24-hour period that a youth is present and receiving TGH services. Even though a youth may not be present for a whole 24-hour period, the day of admission is a patient day. The day of discharge is not a patient day. 

(b)
 
"Therapeutic intervention" is defined in ARM 
37.97.102
(23). 

(c)
 
"Therapy" is defined in ARM 
37.97.102
(26). 

(2)
 
The reimbursement rate for the therapeutic and rehabilitative portion of TGH or TGH with extraordinary needs aide (ENA) services is the lesser of (1)(a) or (b): 

(a)
 
the amount specified in the department's Medicaid Mental Health Fee Schedule as adopted in ARM 
37.85.105
; or 

(b)
 
the provider's usual and customary charges. 

(3)
 
The purpose of the therapeutic services in (1) is: 

(a)
 
to reduce the impairment of the mental disability of the youth and to improve the functional level of the youth; 

(b)
 
to alleviate the emotional disturbances; 

(c)
 
to reverse or change maladaptive patterns of behavior; and 

(d)
 
to encourage personal growth and development. 

(4)
 
TGHs are reimbursed a daily or patient day rate. 

(5)
 
TGH providers must use the procedure codes designated by the department, per the fee schedule in (1)(a) to be reimbursed for TGH, TGH with ENA, or TGH therapeutic home visit (THV) services. 

(6)
 
Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of TGH services. 

(7)
 
Reimbursement will be made to a provider for reserving a TGH bed while the youth is temporarily absent for a THV for a maximum of 14 patient days per state fiscal year. 

Authorizing statute(s):
 
53-2-201
, 
53-6-113
, MCA

Implementing statute(s):
 
53-2-201
, 
53-6-101
, 
53-6-111
, MCA

History: 
NEW, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14.