These sections define, establish eligibility for, and set operational and reimbursement requirements for the Integrated Co-Occurring Treatment (ICT) model, a home- and community-based service for Medicaid-eligible youth with co-occurring serious emotional disturbance (SED) and substance use disorder (SUD). Providers must adhere to the ICT model with fidelity, maintain dually licensed clinical supervisors available 24/7, and deliver an average of three hours of services per week per family. Prior authorization is required through the Children's Mental Health Bureau, and ICT may not be reimbursed concurrently with a range of other services including outpatient therapy, residential, and day treatment programs.
View official source37.87.1350 INTEGRATED CO-OCCURRING TREATMENT (ICT), DEFINITIONS (1) "Community psychiatric supportive treatment (CPST)" means a treatment method that assists a youth and family members or other collaterals to identify strategies or treatment options associated with the youth's mental illness, with the goal of minimizing the negative effects of mental illness symptoms or emotional disturbances or associated environmental stressors which interfere with the youth's daily living, financial management, housing, academic or employment progress, personal recovery or resilience, family or interpersonal relationships, and community integration. (2) "Fidelity" means adherence to the integrated co-occurring treatment (ICT) model, defined in (3). A program which adheres to the ICT model is more likely to replicate the positive outcomes of the model's initial implementation or testing. (3) "Integrated co-occurring treatment (ICT) model" means the ICT model developed by the Center for Innovative Practices at Case Western Reserve University. Services are provided to the fidelity of the model in the home or community where the youth lives, with the goal of safely maintaining the youth in the least restrictive, most normative environment. The frequency and intensity of services may fluctuate based on the needs and unique circumstances of the youth and family. ICT provides a family driven, comprehensive mix of integrated services designed to meet the mental health and substance abuse needs of the youth through implementation of the following services: (a) ICT therapeutic interventions as described in (6); and (b) CPST as described in (1). (4) "ICT clinical supervisor" means a person who is an employee of a provider agency who is dually licensed as a mental health professional, as defined in ARM 37.87.102 (3) and is a licensed addiction counselor (LAC), under 37-35-202 , MCA. (5) "ICT clinician" means a person who is an employee of a provider agency who: (a) is licensed as a mental health professional, as defined in ARM 37.87.102 (3), or is an in-training mental health professional, as defined in ARM 37.87.702 (3); and (b) is a LAC, or is a candidate for licensure, under 37-35-202 , MCA, or will meet the requirements for candidacy under 37-35-202 , MCA, within one year of hire and has completed ICT approved core training. (6) "ICT therapeutic interventions" means crisis response and management; individual and family counseling matched to assessed readiness to change and assessed ability of youth and family, not to include group therapy; and behavioral management and skill training matched to assessed ability of youth and family. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-6-101 , MCA History: NEW, 2016 MAR p. 1856, Eff. 10/15/16. 37.87.1351 INTEGRATED CO-OCCURRING TREATMENT (ICT), ELIGIBILITY (1) ICT services are available to Medicaid eligible youth as defined in ARM 37.87.102 . (2) The youth must have a co-occurring substance use disorder (SUD) as defined by the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and a serious emotional disturbance (SED) as defined in the manual, adopted and incorporated by reference in ARM 37.87.903 . (3) The youth must undergo an integrated bio-psycho-social assessment which supports referral to the ICT program. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-6-101 , MCA History: NEW, 2016 MAR p. 1856, Eff. 10/15/16; AMD, 2020 MAR p. 691, Eff. 11/1/20. 37.87.1352 INTEGRATED CO-OCCURRING TREATMENT (ICT), REQUIREMENTS (1) Providers of ICT must be trained in, and use, ICT as defined by the model. (2) Providers who wish to provide ICT must undergo and pass the following provided by an entity approved by the department: (a) a readiness assessment; and (b) an annual fidelity review. (3) An ICT team must have a minimum of one .125 full-time equivalent (FTE) ICT clinical supervisor and one FTE ICT clinician. (4) One FTE ICT clinical supervisor may supervise up to eight FTE ICT clinicians. (5) The ICT clinical supervisor must provide supervision as defined by the model, including: (a) providing weekly one-on-one supervision; and (b) providing weekly team case consultation to the ICT clinician who holds primary case responsibility. (6) A clinical supervisor who is dually licensed as a licensed mental health professional and a licensed addiction counselor (LAC) must be available 24 hours a day, 7 days a week to the ICT clinicians. (7) One FTE ICT clinician may provide services for up to six families at a time. (8) The following requirements must be met, as described by the ICT model by the ICT clinical supervisor, the ICT clinicians, or both: (a) conduct an average of three hours of ICT services per week with each family through the course of treatment at the frequency, location, and duration that are sufficient to meet the identified needs of the family, unless there is a documented reason that an average of three hours of service per week cannot be met; and (b) provide 24 hours a day, 7 days a week, face-to-face or telephonic crisis response. (9) Treatment begins when the family consents in writing to begin services. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-6-101 , MCA History: NEW, 2016 MAR p. 1856, Eff. 10/15/16. 37.87.1353 INTEGRATED CO-OCCURRING TREATMENT (ICT), REIMBURSEMENT AND AUTHORIZATION (1) A prior authorization (PA) request must be submitted to the Children's Mental Health Bureau no earlier than ten business days prior to the first date of the service for the youth. Requests received earlier than ten days prior to the admission of the youth, will be technically denied. If a request is received after the youth has been admitted, the request will be considered from the date the request was received by the department. (2) The clinical reviewer will complete the PA review process within two business days of receipt of complete information and take one of the following actions: (a) request additional information as needed to complete the review and the provider must submit the requested information within five business days of the request for additional information; (b) authorize the PA for up to 180 days as medically necessary and generate notification to all appropriate parties if the request meets the medical necessity criteria; or (c) defer the case to a board-certified psychiatrist for review and determination if the PA request does not appear to meet the medical necessity criteria. (3) The board-certified psychiatrist will complete the review and determination within four business days of receipt of the information from the clinical reviewer. (4) After a denial, a new PA request may be submitted only if there is new clinical information. (5) The following services will not be reimbursed concurrently with ICT: (a) outpatient therapy; (b) home-support services; (c) community-based psychiatric rehabilitation and support; (d) therapeutic group home; (e) psychiatric residential treatment facility; (f) day treatment; (g) comprehensive school and community treatment; (h) acute inpatient hospital services; and (i) targeted case management. (6) CPST services may be provided by the ICT team to a youth that is enrolled in partial hospitalization for up to 14 days. (7) The ICT provider must provide to the family a document that explains which services cannot be reimbursed concurrently as well as the potential for repayment if such services are provided concurrently. (8) ICT therapeutic interventions will be reimbursed as follows: procedure code H0040 at $18.73 per 15-minute unit. (9) CPST will be reimbursed as follows: procedure code H0039 UA at $14.30 per 15-minute unit. Authorizing statute(s): 53-2-201 , 53-6-113 , MCA Implementing statute(s): 53-6-101 , MCA History: NEW, 2016 MAR p. 1856, Eff. 10/15/16.