ARM 37.90.5

ARM 37.90.5 Targeted Case Management for Adults With Serious Mental Illness or Substance Use Disorder

This rule establishes Medicaid reimbursement rates for Targeted Case Management (TCM) services provided to adults with serious mental illness or substance use disorder who receive HEART Waiver services upon exiting a state-operated secure facility. Reimbursement is calculated on a fee-per-unit basis, with one unit equal to 15 minutes of service, at rates set forth in the department's fee schedule referenced in ARM 37.85.106. Providers must bill in accordance with these established rates.

37.90.501
 HEALING AND ENDING ADDICTION THROUGH RECOVERY AND TREATMENT (HEART), TARGETED CASE MANAGEMENT FOR ADULTS WITH SERIOUS MENTAL ILLNESS OR SUBSTANCE USE DISORDER: REIMBURSEMENT

(1)
 
TCM for Adults with Serious Mental Illness or SUD, who receive HEART Waiver services exiting the state-operated secure facility, will be reimbursed on a fee per unit of service basis as follows.
 
For purposes of this rule, a unit of service is a period of 15 minutes.

(2)
 
The department adopts and incorporates by reference the department's fee schedule which sets forth the reimbursement rates for TCM.
 
The provider reimbursement rate for Targeted case management services for Adults with Serious Mental Illness or SUD, who receive HEART Waiver services exiting the state operated secure facility is stated in the department's fee schedule as provided in ARM 
37.85.106
.

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

Implementing statute(s):
 
53-2-201
, 
53-6-101
, 
53-6-113
, MCA

History: 
NEW, 2026 MAR, Notice No. 2026-170, Eff. 8/22/26.