This regulation establishes the purpose, definitions, provider requirements, and procedures for Montana's Alternatives to Out-of-State Placement program, which aims to keep high-risk youth with serious emotional disturbance in in-state services. Eligible providers must be enrolled Medicaid providers and must be one of four types: licensed mental health centers, therapeutic group homes, psychiatric residential treatment facilities, or 1915(i) home and community-based state plan providers. Qualified providers may access a department-approved data management system to review treatment plans for at-risk youth and propose in-state plans of care, subject to prior authorization requirements.
View official source37.87.1601 ALTERNATIVES TO OUT-OF-STATE PLACEMENT, PURPOSE (1) The purpose of ARM 37.87.601 through 37.86.1606 is to specify provider participation and program requirements to define the basis and procedure available for placement of high-risk children to in-state services as an alternative to out-of-state placement. Authorizing statute(s): 52-2-308 , MCA Implementing statute(s): 52-2-310 , 52-2-311 , MCA History: NEW, 2012 MAR p. 2192, Eff. 10/26/12. 37.87.1602 ALTERNATIVES TO OUT-OF-STATE PLACEMENT, DEFINITIONS (1) ″At risk″ means high-needs youth who have proven challenging for typical in-state placements, and are at risk for out-of-state placement or returning from out-of-state placement. (2) ″Qualified provider pool″ means all in-state Medicaid providers who meet the requirements established in ARM 37.87.1604 and who are granted access to the department-approved data management system. Authorizing statute(s): 52-2-308 , MCA Implementing statute(s): 52-2-310 , 52-2-311 , MCA History: NEW, 2012 MAR p. 2192, Eff. 10/26/12. 37.87.1604 ALTERNATIVES TO OUT-OF-STATE PLACEMENT, PROVIDER REQUIREMENTS (1) Services funded through the program may only be provided by or through a provider that: (a) is enrolled with the department as a Montana Medicaid provider; (b) meets all the requirements necessary for the receipt of Medicaid monies; (c) has been determined by the department to be qualified to provide services to youth with serious emotional disturbance in accordance with the criteria set forth in these rules and must be: (i) a licensed mental health center; (ii) a therapeutic group home; (iii) a psychiatric residential treatment facility; or (iv) a 1915(i) home and community-based state plan provider. (d) is a legal entity; and (e) meets all facility and other licensing requirements applicable to the services covered, the service settings provided, and the professionals employed. Authorizing statute(s): 52-2-308 , MCA Implementing statute(s): 52-2-310 , MCA History: NEW, 2012 MAR p. 2192, Eff. 10/26/12. 37.87.1606 ALTERNATIVES TO OUT-OT-STATE PLACEMENT, PROVIDER PARTICIPATION AND PROCEDURES (1) Qualified providers and acute care hospitals may request access to the system for an alternative to out-of-state placement by supplying an OM300 form which can be obtained by contacting the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210. (2) Department-approved acute care hospitals and the department may place treatment plans on the department-approved data management system for review by qualified providers. (3) Upon approval for access and according to the requirements of this subchapter a qualified provider may review the treatment plans on the department-approved data management system. The qualified provider must follow all applicable department rules, policies, and procedures when proposing a plan of care for providing services in-state for at-risk youth. (4) All services that require prior authorization must be prior authorized in accordance with ARM 37.87.903 . Authorizing statute(s): 52-2-308 , MCA Implementing statute(s): 52-2-310 , 52-2-311 , MCA History: NEW, 2012 MAR p. 2192, Eff. 10/26/12.