(1) The purpose of the rules in this subchapter is to establish standards for the approval of programs providing prevention, treatment, rehabilitative, and recovery services to individuals with substance use disorders and substance related issues, as provided in Title 53, chapter 24, part 2, MCA.

(2)  Each public or private substance use disorder program providing services and receiving alcohol earmarked revenue funds under 53-24-108, MCA, shall be subject to approval by the department.  The department will issue approval for the following substance use disorder (SUD) levels of care and specialty services, outlined in the American Society of Addiction Medicine (ASAM) Criteria and Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Manual:

(a)  ASAM 3.7 Medically Monitored Intensive Inpatient Services;

(b)  ASAM 3.7-WM Medically Monitored Withdrawal Management Services;

(c)  ASAM 3.5 Clinically Managed High-Intensity (adult) and Medium Intensity (adolescent) Residential Services;

(d)  ASAM 3.3 Clinically Managed Population-Specific High Intensity (adult only) Residential Services;

(e) ASAM 3.2-WM Clinically Managed Residential Withdrawal Management Services;

(f) ASAM 3.1 Clinically Managed Low Intensity (adult or adolescent) Residential Services;

(g) ASAM 2.5 Partial Hospitalization Services;

(h)  ASAM 2.1 Intensive Outpatient Services;

(i) ASAM 1.0 Outpatient Services;

(j) ASAM 0.5 Early Intervention;

(k) SUD Prevention;

(l) SUD Certified Behavioral Health Peer Support Services; and

(m)  SUD Targeted Case Management.

In addition to the terms defined in 53-24-103 , MCA:

(1) "American Society of Addiction Medicine (ASAM) Criteria" means guidelines for placement, continued stay, and transfer/discharge of individuals with addiction and co-occurring conditions developed by the American Society of Addiction Medicine.

(2) "BHDD Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health adopted and incorporated in ARM 37.27.902. The manual can be found at: https://dphhs.mt.gov/amdd/AMDDMedicaidServicesProviderManual.

(3) "BHDD Non-Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Non-Medicaid Services Provider Manual for Substance Use Disorder adopted and incorporated in ARM 37.27.902. The manual can be found at: https://dphhs.mt.gov/amdd/AMDDNonMedicaidServicesProviderManual.

(4) "Biopsychosocial assessment" means a comprehensive multidimensional assessment process that includes risk ratings, addresses immediate needs, and is organized in accordance with the six dimensions described in the ASAM Criteria and meets the requirements described in the BHDD Medicaid Manual.

(5) "Continuing care plan" means a plan for when a client is discharged or transferred from a particular level of care as described in the BHDD Medicaid Manual.

(6) "Facility" means a public or private organization as defined in 50-5-101, MCA. Programs approved under ARM 37.27.105 and 37.27.107 are not considered a facility.

(7) "Individualized treatment plan" means a plan of care developed in collaboration with the patient, as described in the BHDD Medicaid Manual.

(8) "Licensed addiction counselor (LAC)" means an individual licensed under requirements pursuant to Title 37, chapter 35 MCA, and ARM Title 24, chapter 219, subchapter 50, to provide addiction counseling. References in ARM 37.27.107 to a LAC do not include an addiction counselor licensure candidate registered pursuant to Title 37, chapter 35, part 2, MCA.

(9) "Program" is the general term for an organized system of services designed to address the treatment needs of clients.

(10) "Progress note" is a written record of a treatment session or service contact as defined in the BHDD Medicaid Manual.

(11) "Provisional approval" means a status of state approval granted to chemical dependency treatment programs which are requesting approval for the first time and which have not attained substantial compliance specified in these rules.

(12) "Restricted approval" means a status of provisional state approval granted to a state approved program which has failed to maintain substantial compliance to enable it to meet the requirements of this subchapter. Restricted status is issued for a maximum of 90 days in order to allow programs to meet requirements. This approval cannot be renewed.

(13) "Revoke" means invalidation of state approval of a program.

(14) "State approved program" means a program reviewed and accepted by the department to provide substance use disorder prevention, treatment, rehabilitation, and/or recovery services.

(15) "Substance use disorder (SUD)" means chemical dependency, as defined in 53-24-103, MCA.

(16) "Suspension" means invalidation of state approval of a treatment program for any period less than one year or until the department has determined that the program meets all requirements of this subchapter and notifies the program of reinstatement.

(1) In order to be reimbursed for prevention services, a prevention provider must be state approved and:

(a) have a contract with the department for substance abuse primary prevention services;

(b) be the Montana Public Health Institute; or

(c) be a county or tribal public health department.

(2) In order to become state approved, a prevention provider must complete and submit to the department the designated application.

(3) If the application and supporting documentation do not meet the application requirements, the department will notify the applicant in writing identifying the incomplete or missing information within 30 days of receipt of the application.

(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.

(b) If a response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.

(4) If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Provisional approval is granted to provide time to comply with standards. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely.

(5) The provider must submit the requested documentation to the department or provide access to the provider's premises for inspection.

(6) Within 20 days of the inspection, the department shall issue final approval or deny the application and shall send written notification of full approval or denial to the applicant.

(7) Upon receiving full approval, a provider may provide prevention and early intervention services as described by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

(8) The department will annually inspect the provider, on-site or remotely, to ensure the provider continues to meet requirements of this rule.

(9) Approved providers must follow the American Society of Addiction Medicine (ASAM) Criteria in the provision of early intervention services and adhere to requirements outlined in the BHDD Medicaid Services Provider Manual for SUD and Adult Mental Health located at: https://dphhs.mt.gov/amdd/AMDDMedicaidServicesProviderManual.

(1) In order to be reimbursed for SUD facility-based treatment services, a SUD facility must be state approved and licensed pursuant to ARM Title 37, chapter 106, subchapter 14.

(2) In order to become state approved, the SUD facility provider must complete and submit the designated application to the department. The SUD facility must be licensed for the level(s) of care indicated in the application.

(3) If the application and supporting documentation do not meet the application requirements, the department will notify the applicant in writing identifying the incomplete or missing information within 30 days of receipt of the application.

(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.

(b) If the response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.

(4) If the application and supporting documentation meet the application requirements, the department shall issue full approval. Documentation must include evidence of an active facility license.

(5) The department shall issue a final approval or deny the application and shall send written notification of full approval or denial to the applicant.

(6) The department will reimburse a state approved facility for SUD facility-based services, as outlined in the BHDD Medicaid Manual, using appropriate Common Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes on applicable department fee schedules.

(7) The department will inspect the facility once every two years, on-site or remotely, to ensure the facility continues to meet the requirements of this rule.

(8) The provider must submit the requested documentation to the department or allow the department access to the provider's premises for inspection.

(9) Approved facilities must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Manual.

(1) In order to be reimbursed for outpatient services, an individual outpatient treatment provider must be state approved and be a licensed addiction counselor.

(2) In order to become state approved, the licensed addiction counselor (LAC) must complete and submit the designated application to the department.

(3) If the application and supporting documentation do not meet the application requirements, the department will notify the applicant in writing identifying the incomplete or missing information within 30 days of receipt of the application.

(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.

(b) If a response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.

(4) If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Provisional approval is granted to provide time to comply with standards. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely.

(5) The provider must submit the requested documentation to the department or allow the department access to the provider's premises for inspection.

(6) Within 20 days of the inspection, the department shall issue final approval or deny the application and shall send written notification of full approval or denial to the applicant.

(7) The department will reimburse a state approved outpatient treatment provider for American Society of Addiction Medicine (ASAM) level of care 1.0, Outpatient Services, using appropriate Common Procedural Terminology (CPT) codes.

(8) The department will annually inspect the provider, on-site or remotely, to ensure the provider continues to meet requirements of this rule.

(9) Approved providers must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Services Provider Manual.

This rule has been repealed.

(1) The program shall ensure compliance with 53-24-209, MCA.

(2) The program shall admit and care for only those persons for whom it can provide care and services appropriate to the person's physical, emotional, and social needs.

(3) The program shall work together with the client to implement a written individualized treatment plan that identifies services and supports needed to address problems and needs identified in the biopsychosocial assessment. The individualized treatment plan is maintained on a current basis for each client.

(4) The program shall make appropriate referrals when the client needs services not offered by the program.  Referrals must be documented in the client record.

(1) Programs approved under ARM 37.27.105 and 37.27.107 that provide treatment (including early intervention) must develop and maintain a client rights policy that supports and protects the state and federal constitutional and statutory rights, including civil rights, of all clients. These must include the right to:

(a) receive treatment free of unlawful discrimination;

(b) receive reasonable accommodations, consistent with federal and state law;

(c) receive treatment in the least restrictive environment, consistent with law, in a manner sensitive to individual needs and which promotes dignity and self-respect;

(d) have all clinical and personal information treated in accordance with state and federal confidentiality statutes and regulations;

(e) practice the religion of the client's choice, consistent with the Montana Religious Freedom Restoration Act and consisting the rights of others and the requirements of the treatment program. The client also has the right to be excused from any religious practice;

(f) review their own treatment records in the presence of treatment staff, consistent with 45 CFR 164.524 and other state and federal confidentiality statutes and regulations;

(g) be fully informed of fees charged, including fees for copying records to verify treatment and methods of payment available;

(h) be free from abuse, neglect, and financial exploitation by staff members or clients;

(i) have grievances considered in a fair and timely manner, with respect to infringements of rights described in this rule;

(j) be given a 30-day notice in the event of program closure or discontinuation of treatment services;

(k) be provided with a referral to similar treatment services, if available; and

(l) be advised how to access records to which the client is entitled.

(2) The program must inform each client and his or her representative, in an understandable manner, of the rights policy, treatment methods, and rules applicable to the client, at the time of admission or as soon thereafter as the client is capable of rational communication.

(3) The client and staff member reviewing the policy must sign a statement acknowledging the review. The statement must be maintained in the client's record.

(4) The program must post a copy of client rights in a conspicuous place in the facility, accessible to clients and staff members.

(1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a written client confidentiality policy pursuant to 42 CFR Part 2. 

(2) The confidentiality policy must be reviewed with the client at the time of admission or as soon thereafter as the client is capable of rational communication.

(3) Policy requirements must include activities to:

(a) inform clients that federal law and regulations protect the confidentiality of alcohol and drug abuse client records; and

(b) provide clients with a summary in writing of the federal law and regulations.

(4) The written summary required in (3)(b) must include:

(a) a general description of limited circumstances under which a SUD program may acknowledge a client is present at a facility or disclose information identifying a client as an alcohol or drug abuser;

(b) a statement that violation of the federal law and regulations by a SUD program is a crime and suspected violations may be reported to appropriate authorities in accordance with these regulations;

(c) a statement that information related to a client's commission of a crime on the premises of the SUD program or against staff members of the SUD program is not protected;

(d) a statement that reports of suspected child abuse or neglect made under state law to appropriate state or local authorities are not protected; and

(e) a citation to the federal law and regulations.

(5) Client consent must be obtained for each release of information to any other person or entity if required under 42 CFR Part 2. The consent for release of information must have specific information pursuant to 42 CFR Part 2.

(1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a policy for communicable disease control. 

(2) The communicable disease policy must be reviewed annually and include:

(a) procedures to identify high risk individuals;

(b) specific procedures to address tuberculosis (TB), Hepatitis A, Hepatitis C, sexually transmitted infections (STI), and human immunodeficiency virus (HIV); and

(c) the identification of methods used to protect, contain, or minimize the risk to clients and staff members.

(3) The program is responsible for the direction, provision, and quality of infection prevention and control services.

(4) Programs must implement TB protocols for all staff members and clients based upon an annual TB Risk assessment as set forth by the Montana Tuberculosis Prevention and Control Program pursuant to ARM Title 37, chapter 114, subchapter 10. Risk assessment and TB manuals are found at https://dphhs.mt.gov/publichealth/cdepi/diseases/Tuberculosis/.

(1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a policy that: 

(a) clearly defines child abuse and neglect as defined in 41-3-102, MCA;

(b) clearly defines abuse, neglect, and exploitation of an older person or a person with a developmental disability as defined in 52-3-803 MCA;

(c) outlines the provider's responsibility to report all known or suspected incidents of abuse, neglect, or exploitation of any client within 24 hours; and

(d) addresses handling of suspected or validated incidents of abuse, neglect, or exploitation.

(2) Any provider who knows or has reasonable cause to suspect an incident of child abuse or neglect has occurred must make a report within 24 hours of the incident to the state child abuse hotline (866) 820-5437 as required in 41-3-201, MCA.

(3) Any provider who knows or has reasonable cause to suspect an incident of abuse, neglect, or exploitation of a vulnerable adult has occurred must make a report within 24 hours of the incident to Adult Protective Services or other bodies as required in 52-3-811, MCA.

(4) In addition to reporting requirements in (2) and (3), the provider must also make a report to the department in writing within 24 hours of any allegations of client abuse, neglect, or exploitation within the program.

(5) The program must document, in writing, that the proper authorities have been contacted and the abuse, neglect, or exploitation has been reported.

(6) The provider must fully cooperate with any investigation conducted because of the report.

(1) The organization and management of all state approved programs shall ensure that:

(a) The program has written policies and procedures required by this subchapter.

(b) The program will develop and conduct annual program evaluations or review to assess the quality, appropriateness, and efficacy of treatment services provided. This review should examine the following:

(i)  admission criteria/intake process;

(ii) assessments;

(iii)  treatment planning;

(iv) documentation of implementation of treatment services;

(v) discharge and continuing care planning; and

(vi) indications of treatment outcomes.

(c) The program will monitor the following treatment outcomes:

(i) demographics;

(ii) no shows;

(iii) wait times;

(iv) abstinence and reduction of the use of substances;

(v) involvement with the criminal justice system;

(vi) stable employment, school, or training;

(vii) housing stability;

(viii) retention in services;

(ix) perception of care;

(x) social connectedness; and

(xi) use of evidence-based practices.

(d) Client records are retained according to the following guidelines:

(i) If a state approved chemical dependency program is receiving public funds through a contract, grant or written agreement with federal, state, county or city agencies, records must be retained 5 years beyond the termination date of said contract, grant, or written agreement. Records shall be retained beyond the 5 year period if an audit is in process or if any audit findings, lawsuits, or claims involving the records have not been resolved. The retention period for each year's records starts from date of submission of the annual or final report of expenditures (financial status report or equivalent) .

(ii) If a state approved program is not receiving public funds (federal, state, county or city), records must be retained 5 years beyond the fiscal year end (June 30th) in which that client was most recently discharged from that program. Records shall be retained beyond the 5 year period if an audit is in process or if any audit findings, lawsuits, or claims involving the records have not been resolved.

(e) Facilities and offices are clean and well maintained.

(f) Accounting and fiscal procedures are adopted which ensure financial accountability and meet all federal, state, and county requirements.

(g) A sliding fee schedule is adopted based on ability to pay for all individuals receiving treatment services provided by state approved programs. (53-24-108(4), MCA).

(h) The program maintains general liability insurance and professional liability insurance.

(i) Client records and documentation adhere to requirements described in the BHDD Medicaid Manual and ARM 37.85.414.

(j) Programs will submit quarterly updates to the department to ensure contact information, organizational chart, locations, hours of operation, and services provided are up to date.

This rule has been repealed.

(1) The department, after written notice to the program, may sanction a program's state approval upon finding that the program: 

(a) fails to meet any state approval requirements established by this subchapter;

(b) fails to meet regulations or licensure standards set forth in ARM Title 37, chapter 106, subchapter 14;

(c) has failed to use state or federal funds received under contract with the department or through Montana Medicaid as required, pursuant to state or federal regulations, for the operations of a program or provision of services;

(d)  has failed to comply with a performance action plan approved by the department;

(e) has committed unprofessional conduct pursuant to 37-1-316, MCA;

(f) has current orders or sanctions pursuant to 37-1-312, MCA; or

(g) has current sanctions pursuant to ARM Title 37, chapter 85, subchapter 5.

(2) The department will issue a 90-day restricted state approval to a program that has failed to meet requirements of this rule and has submitted a performance action plan approved by the department.

(3) The department will issue a suspension of state approval, for up to one year, to a program that has failed to meet requirements of this rule during a restricted state approval and has submitted a performance action plan approved by the department.

(a) Programs approved under ARM 37.27.107 will receive an immediate suspension of state approval if their professional license has been suspended by the licensing board. Suspension will be the same length of time determined by the licensing board or one year, whichever is greater.

(4) The department will revoke a program's state approval if the program:

(a) has failed to meet requirements of this rule during a suspension of their state approval;

(b) has been excluded from participation in a government health care program; or

(c) approved under ARM 37.27.107, has had its professional license revoked by the licensing board.

(5) A restriction or suspension of state approval may only be issued one time within a two-year period.

(6) Any program whose state approval has been revoked under the provisions of this subchapter may not submit another application for state approval within one year from the date of revocation and all deficiencies identified in the performance action plan have been corrected.

(7) Any program whose state approval has been restricted, suspended, or revoked has the right to request a hearing as set forth in ARM Title 37, chapter 5, subchapter 3.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1)  The purpose of the rules in this subchapter is to establish standards for the Substance Use Disorder Voucher Program, as provided in Title 53, chapter 24, part 2, MCA. 

(2)  This program is intended to cover the cost of substance use disorder treatment room and board that is not otherwise covered by insurance or another assistance program.

(3)  This program is subject to available funding.

In addition to the terms defined in 53-24-103, MCA, the following definitions shall apply in the interpretation and enforcement of the rules in this subchapter:

(1)  "American Society of Addiction Medicine (ASAM) Criteria" means guidelines for placement, continued stay, and transfer, or discharge of individuals with addiction and co-occurring conditions developed by the American Society of Addiction Medicine.

(2)  "ASAM 3.1" means substance use disorder clinically managed low-intensity residential treatment services for adults or adolescents, which is a level of care described in the ASAM Criteria.  ASAM 3.1 is a licensed community-based residential facility that functions as a supportive, structured living environment.  Individuals are provided stability and skills building to help prevent or minimize continued substance use.  This level of care includes a minimum of five hours per week of professionally directed treatment services.

(3)  "BHDD Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health adopted and incorporated by reference in ARM 37.27.902.  The manual can be found at: https://dphhs.mt.gov/BHDD/BHDDMedicaidServicesProviderManual.

(4)  "Substance use disorder" means chemical dependency, as defined in 53-24-103, MCA.

(1)  In order to participate in the substance use disorder voucher program, an individual must: 

(a)  live in Montana;

(b)  be 14 years of age or older;

(c)  have an annual family income at or below 200% of federal poverty guidelines;

(d) meet medical necessity described in the BHDD Medicaid Manual for ASAM 3.1 services;

(e)  receive a prior authorization for ASAM 3.1 services from the Quality Improvement Organization (QIO); and

(f)  currently be receiving ASAM 3.1 services.

(1)  In order to be reimbursed for room and board under the Substance Use Disorder Voucher Program in ARM 37.27.201, a program must be a state-approved substance use disorder facility under ARM 37.27.106 and licensed as an ASAM 3.1 substance use disorder facility pursuant to ARM Title 37, chapter 106, subchapter 14. 

(2)  A provider that meets requirements in ARM 37.27.203 and seeks reimbursement for room and board under the Substance Use Disorder Voucher Program must complete and submit the designated request form to the department to obtain reimbursement for such services provided to a qualified individual.

(3)  The department will review the request and provide approval or denial to the provider within 10 working days of receipt of the request.

(4)  If the request is approved, the department will issue payment to the provider.

(5)  The department will reimburse providers as outlined in contract or policy.

(2) County plan updates are to be submitted to the department of public health and human services by 5:00 p.m. December 31 of each year that a comprehensive 4-year county plan is not required.

(2) Analysis of county needs. County(ies) must analyze and describe the extent of their alcohol and drug problems within the county(ies) covered by the plan which includes a description of programs or services offered by alcohol and drug programs. To be submitted every 4 years with comprehensive plan.

(3) Treatment and rehabilitation. County( ies ) must list the names and services provided by existing chemical dependency programs within the county( ies ) . If all service components (detoxification, inpatient [hospital and free standing], intermediate-transitional living, outpatient) are not available within the county( ies ) service area, provisions must be made to obtain these services on a referral basis. Planned expansion of services should be included in this section as well as delineation of problems encountered in delivering services. To be submitted with comprehensive plan every 4 years.

(4) Fiscal year county action strategy. County( ies ) must list programs to receive alcohol tax monies during next fiscal year and determine what services each will provide and estimate allocation by service component (i.e., detoxification, outpatient, etc.) of county funds for each program. To be submitted by December 31 of each year.

(5) Prevention. County( ies ) must assess and describe chemical dependency prevention services available within the county( ies ) service area. To be submitted every 4 years with comprehensive plan.

(2) Only chemical dependency treatment programs and facilities approved under 53-24-208 , MCA, and ARM 37.27.101 through 37.27.136 may receive approval for chemical dependency educational courses. Procedures for approval of educational courses will be the same as those specified in ARM 37.27.101 through 37.27.136.

(3) Chemical dependency treatment programs will charge the offender for the educational course utilizing the following:

(a) Educational courses and 1 year monitoring will be self supporting and fees charged will be based on actual costs.

(b) Initial fees (as of the effective date of this rule) and future fee increases must be reviewed and approved by the department.

(c) Offenders referred to treatment and/or monitoring via the assessment process are responsible for the costs of treatment and monitoring.

(1) "Abuser" means the offender meets the DSM-IV diagnostic criteria for substance abuse.

(2) "ACT (assessment, course, treatment) program" means an assessment, educational course and/or referral to treatment. This is a three part process designed to assess, educate and to recommend treatment placement as appropriate for persons convicted of driving under the influence of intoxicating substances, UDD, MDD and third or subsequent MIP.

(3) "ACT curriculum manual" means a manual developed by department of transportation traffic safety bureau which specifically defines the course curriculum for the ACT program.

(4) "Aftercare" is defined in ARM 37.27.102.

(5) "Assessment" means, for the purpose of this subchapter, the process of identifying and labeling specific conditions such as chemical abuse or dependence; and the determination of the appropriate level of treatment for the offender. This process is described in ARM 37.27.515(1) (a) through (d) .

(6) "Assessment/evaluation instruments" are those diagnostic and screening tools utilized primarily to provide information for the counselor to assist in making a determination of the severity of an offender's chemical use. A list of suggested assessment/evaluation instruments may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, P.O. Box 202951, Helena, MT 59620-2951.

(7) "Certified chemical dependency counselor" means an individual meeting standards pursuant to 53-24-204 , MCA, and corresponding rules and regulations described in ARM 20.3.401 through 20.3.406.

(8) "Chemically dependent" means the offender meets the DSM-IV criteria for substance dependence.

(9) "Cross-referencing" is a method used to determine if similar questions are answered in the same manner on different assessment instruments. The purpose is to discover consistencies and inconsistencies in an offender's answers to questions and assess the validity of the offender's self-report.

(10) "Continuing care" refers to the aftercare recommendations of the treatment provider.

(11) "Driver control" means the records and driver control bureau of the department of justice.

(12) "DUI" means driving under the influence and, for the purpose of these rules, includes violation of an offense under 61-8-401 , MCA.

(13) "Inpatient treatment" is defined in ARM 37.27.102 and the requirements are found in ARM 37.27.129 and 37.27.130.

(14) "Intensive outpatient" is defined in ARM 37.27.102 and the requirements are found in ARM 37.27.138.

(15) "MDD" means a misdemeanor dangerous drug offense under 45-2-101 , MCA, for which completion of a dangerous drug information course is mandatory.

(16) "MDD program" means an assessment, educational course and/or referral to treatment. This is a three part process designed to assess, educate and to recommend treatment placement as appropriate for persons convicted of misdemeanor dangerous drug offense. Compliance with treatment recommendations will be at the discretion of the sentencing judge.

(17) "MDD curriculum" means the 8-hour course provided to those convicted of an MDD offense. The course may utilize the ACT curriculum manual and must include specific review of the misdemeanor drug laws and the harmful effects of dangerous drug use.

(18) "MIP (minors in possession) " means minors convicted of possession of an intoxicating substance, unlawful attempt to purchase an intoxicating substance under 45-5-624 , MCA.

(19) "MIP curriculum manual" means a manual developed by the department of public health and human services which defines the MIP course curriculum and the requirements for performing chemical dependency evaluations and referral to treatment.

(20) "MIP education course" means the community-based substance abuse information course for minors under l8 years of age convicted of an MIP under 45-5-624 or 61-8-410 , MCA.

(21) "Misuser/no patterns" means the offender does not meet the DSM-IV diagnostic criteria for either substance abuse or dependence.

(22) "Monitoring" is a process to ensure compliance with continuing care recommendations for second or subsequent offenders.

(23) "Offender" means a person convicted of DUI/per se/UDD, MIP, or a dangerous drug misdemeanor and sentenced to complete a chemical dependency educational course provided by a state approved program and/or treatment provided by a certified chemical dependency counselor.

(24) "Outpatient" is defined in ARM 37.27.102 and the requirements are found in ARM 37.27.138.

(25) "Per se" means for the purpose of this subchapter, violating the provisions of 61-8-406 , MCA, operation of vehicle by a person with alcohol concentration of 0.10 or more.

(26) "UDD" means underage drinking and driving, the operation of a vehicle by a person under the age of 21 with an alcohol concentration of 0.02 or more. For the purpose of these rules, this includes violation of an offense under 61-8-410 , MCA.

(27) "Unidentified" means the offender did not complete the assessment or exhibited a level of denial that made diagnosis impossible.

(2) The ACT program is a three part process which includes:

(a) Assessment, which is the evaluation component utilized to identify chemical use patterns of DUI/per se/UDD offenders and to make appropriate recommendations for education and/or treatment. Misdemeanor dangerous drug offenders may complete the assessment with the ACT program or a state approved treatment program which offers an MDD education program.

(b) Course, which is an educational component based on the curriculum contained and explained in ARM 37.27.516 and further defined in the ACT course curriculum manual. The manual may be obtained from the Department of Transportation, Traffic Safety Bureau, 2701 Prospect Avenue, P.O. Box 201001, Helena, MT 59620-1001. Misdemeanor dangerous drug offenders must complete a specific drug education course equivalent in hours to the ACT curriculum. The course will be based on the ACT curriculum but must contain specific information on misdemeanor drug laws. The MDD course may be combined with or held separately from the DUI course. If more than eight MDD clients are enrolled at one time on a consistent basis, it is recommended that the courses be offered separately.

(c) Treatment, which is defined in 53-24-103 , MCA. Standards for treatment are required by 53-24-208 , MCA, and ARM 37.27.101 through 37.27.136. The need for treatment services must be documented and verified through assessment and state approved patient placement procedures. Treatment may be provided by the treatment program conducting the ACT program or through a referral to another treatment program.

(i) First DUI/per se/UDD offenders assessed as chemically dependent, all second and subsequent DUI/per se/UDD offenders and MDD offenders ordered by the court must complete all three components of the ACT program. The treatment provided must be at a level appropriate to the offender's alcohol/drug problem, based upon patient placement criteria as defined in ARM 37.27.120.

(3) To complete the ACT program, the offender:

(a) must enroll by the date specified by the sentencing court. If no date is specified, then within 10 days of the ACT program's receipt of the court referral notice;

(b) must start the course process within 30 days of the program's receipt of the court referral notice; and

(c) must complete the program in a minimum of 30 days from the date of enrollment, but no longer than 90 days from the date of enrollment. An exception to the 30-day minimum may be granted by the department based only on justified geographical considerations. The ACT program will notify the sentencing courts in all cases of failure to comply and the sentencing court may notify the drivers control bureau.

(2) A person 18 to 20 years of age, who is convicted of a third or subsequent offense of possession of an intoxicating substance under 45-5-624 , MCA, and ordered to complete an alcohol information course at a state approved program shall attend and complete the ACT program, with all of its requirements.

(a) a minimum of three assessment/evaluation instruments must be utilized and cross-referenced as part of the assessment process. Assessment instruments are as defined in ARM 37.27.502;

(b) a minimum of two individual assessment interview sessions with a certified chemical dependency counselor must be documented in the assessment process;

(c) based on the results of the assessment process, the offender will be classified as misuser/no patterns, abuser, chemically dependent or unidentified. The results of the assessment must be documented in the offender's file; and

(d) an evaluation and recommendation report must be submitted by a certified chemical dependency counselor to the sentencing court if a first DUI/per se/UDD offender is diagnosed as chemically dependent and recommended for treatment or the DUI/per se/UDD offender has a second or subsequent offense.

(i) The report must include the assessment instruments utilized, results of the testing, problem indicators, assignment to one of the four assessment categories (i.e., misuser/no patterns, abuser, chemically dependent or unidentified) , and recommendation for treatment and corresponding rationale based on patient placement criteria as defined in ARM 37.27.120 which determines appropriate level of care.

(ii) A MDD offender diagnosed as chemically dependent will be referred back to the court with a treatment recommendation. Compliance with treatment is contingent upon the court's approval of the treatment recommendation.

(2) The process for recommending treatment shall be as follows:

(a) If a DUI/per se/MDD/UDD offender is assessed as chemically dependent or is a repeat DUI/per se/UDD offender, recommendations for treatment must be developed by the program counselor in accordance with state approved patient placement rules. The offender may disagree with the program recommendations and seek an independent assessment from a certified chemical dependency counselor. The determination from this assessment must be based on diagnosis and patient placement rules adopted by the department of public health and human services. Offenders must be advised of this right by the program.

(b) Following completion of the assessment, the certified chemical dependency counselor will submit an evaluation/recommendation report to the sentencing court which includes a determination of the appropriate model of treatment based upon state approved placement criteria. Treatment recommendations may include inpatient with aftercare, intensive outpatient with aftercare or outpatient scheduled at least once per week.

(c) Pursuant to 61-8-732 , MCA, the sentencing court must order compliance with treatment recommendations in the case of first DUI/per se/UDD offenders assessed as chemically dependent or repeat DUI/per se/UDD offenders. When the offender has disagreed with recommendations and obtained a second opinion, the sentencing court shall order the appropriate level of treatment as determined by one of the counselors.

(d) The offender may attend the approved assessment/ education and/or treatment program of the offender's choice. The approved program or certified chemical dependency counselor accepting an ACT program referral to treatment must notify the sentencing court upon completion of treatment, or upon an offender's failure to complete.

(e) Copies of the evaluation and recommendation report must be documented in the offender's file and given to the offender.

(f) A sentencing court or counselor may not require attendance at a self-help program unless the meeting is defined as "open" by the self-help program.

(1) Course curriculum shall include the following (specific content of the topic areas below may be found in the ACT curriculum manual):

(a) The DUI/UDD and/or MDD educational component must include a minimum of four educational sessions totaling at least 8 hours.

(b) The curriculum will include four major topic areas:

(i) review of the laws and consequences of violating them;

(ii) physiological/ neurophysiological effects of alcohol and other drugs;

(iii) social and psychological implications of alcohol and other drug use; and

(iv) self assessment.

(c) The MDD curriculum must contain a specific review of MDD laws.

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(1) One year monthly monitoring requirements:

(a) Those offenders with a second or subsequent conviction must be monitored for compliance with continuing care recommendations;

(b) Monitoring will consist of at least one face to face individual and/or group contact per month, conducted by a certified or eligible as a chemical dependency counselor, for a period of 1 year from the date of admission to the treatment program; and

(c) The treatment provider, providing the monitoring services, will notify the sentencing court within 10 days if the offender fails to comply with the continuing care recommendations.

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(1) Program staff requirements are as follows:

(a) Individual assessment sessions must be provided by a certified chemical dependency counselor;

(b) Assessments which recommend treatment must be performed, signed and dated by a certified chemical dependency counselor; and

(c) Staff conducting the educational course component must receive an ACT program specific training course sponsored by the traffic safety bureau within 6 months from the date of hire and also be certified or eligible as a chemical dependency counselor as defined in ARM 20.3.401 through 20.3.416.

(2) Programs shall develop policies and procedures which address the ACT program requirements of these rules and shall include:

(a) Services and staff requirements;

(b) Procedures for determining cost and fees charged for the ACT program; and

(c) Goals and objectives which address required effectiveness indicators shall include, but not be limited to ACT caseload, completion ratios, numbers of offenders recommended for treatment, and number of repeat offenders.

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(a) Alcohol and drug information system (ADIS) admission/discharge ACT program report;

(b) assessment instruments utilized;

(c) progress notes documenting the assessment interviews, which includes data to validate the assessment findings and treatment placement recommendations when appropriate and includes the counselor's observations and conclusions;

(d) documentation of educational sessions attended, dates of assessment interviews, and tracking summaries;

(e) evaluation and recommendation reports;

(f) court sentencing orders or referral forms;

(g) release of confidential information forms to the sentencing court and driver control bureau signed upon admission, and other forms as required;

(h) documentation of referral to or from another ACT program when applicable;

(i) fee charges and documentation of ability to pay if required;

(j) documentation of non-compliance where applicable; and

(k) biopsychosocial and patient placement documentation; and

(l) advisal of rights form.

(1) The Montana chemical dependency center (MCDC) is an approved public inpatient facility which provides inpatient (free standing) treatment to chemically dependent residents of Montana who demonstrate a severity of illness which matches the intensity of service.

(1) "Level of care" means the following for the purpose of this rule:

(a) level IV - inpatient (hospital) care as defined in ARM 37.27.102(13); requirements are found in ARM 37.27.129.

(b) level III - inpatient (free standing) care as defined in ARM 37.27.302(13); requirements are found in 37.27.130.

(c) level II - day treatment and/or intensive outpatient treatment as defined in ARM 37.27.102(8) and (15); requirements are found in ARM 37.27.137 and 37.27.138.

(d) level I - outpatient treatment as defined in ARM 37.27.102(18); requirements are found in ARM 37.27.136.

(2) "Level III justification packet" means the materials to be sent to MCDC by the certified counselor (as defined in ARM 20.3.401 through 20.3.416) to justify the admission which include the following required items:

(a) results of assessment as defined in ARM 37.27.130;

(b) copy of the biopsychosocial assessment as defined in ARM 37.27.102(4), completed by a certified counselor;

(c) level III patient placement justification as defined in ARM 37.27.130;

(d) identification of overriding considerations as defined in ARM 37.27.120(1)(j)(vii) if appropriate;

(e) confirmation that appropriate services are not available locally; and

(f) current discharge summary as defined in ARM 37.27.136(5)(j), if recently discharged from another level of care.

(3) "Supporting documentation" means any documentation of the history of medical or psychiatric concerns which substantiates the need for level II care and/or negates the need for level IV care.

(4) "Qualifying placement" means justification at level III in at least two of the six dimensions, as defined in ARM 37.27.120(1)(j)(i) through (vii) or one dimension with a consideration which overrides the patient placement match.

(5) "MCDC utilization review committee" means a team with clinical, medical and administrative representation, which determines the appropriateness of admission level III treatment based on the documentation submitted by the certified chemical dependency counselor.

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(2) The certified chemical dependency counselor must contact the admission coordinator at MCDC and request admission. The admissions coordinator will instruct the program or certified counselor in admission protocols.

(3) The certified counselor will send the completed level III justification packet and supporting documentation to MCDC.

(4) The MCDC utilization review committee will meet 5 days per week (Monday through Friday except holidays) to process and accept requests for admissions within 24 hours, providing the documentation within the level III justification packet is complete. Requests received after 11:00 a.m. on Friday will be processed on Monday.

(5) The committee may reject requests for admission based on inadequate documentation or inappropriate placement.

(6) The referring certified chemical dependency counselor will be notified of the deficiencies and be given the opportunity to correct the deficiencies and resubmit.

(7) Following acceptance of the admission request, MCDC will notify the referring certified chemical dependency counselor or state approved program of the specific date and time for the admission. The referring certified chemical dependency counselor or state approved program is responsible to arrange the travel so the individual arrives at the designated arrival time.

This rule has been repealed.

(1) The purpose of rules contained in this subchapter is to establish standards for the coverage and reimbursement of substance use disorder services under the Montana Medicaid Program.

(2) In addition to the requirements contained in rule, the department has developed and published the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health, dated July 1, 2023, which it adopts and incorporates by reference. The purpose of the manual is to implement requirements for utilization management and services. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities (BHDD) Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at: https://dphhs.mt.gov/bhdd/BHDDMedicaidServicesProviderManual.

(3) In addition to the requirements contained in rule, the department has developed and published the BHDD Division Non-Medicaid Services Provider Manual for Substance Use Disorder, dated July 1, 2023, which it adopts and incorporates by reference. The purpose of the manual is to implement requirements for utilization management and services. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities (BHDD) Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena MT 59620-2905 or at: https://dphhs.mt.gov/bhdd/BHDDNonMedicaidServicesProviderManual.

(1) General Medicaid provider requirements found in ARM 37.85.104 through 37.85.1125 are applicable to all Medicaid substance use disorder services.

(2) HELP Medicaid requirements found in ARM 37.84.101 through ARM 37.84.115 are applicable to all Medicaid substance use disorder services.

(3) All services must be delivered by facilities or programs approved by the department.

This rule has been repealed.

(1) Medicaid substance use disorder programs must bill for services using procedure codes, modifiers, and definitions contained in the:

(a) Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Code System (HCPCS); and

(b) American Medical Association's (AMA) Current Procedural Terminology (CPT) Codes.

(2) Subject to requirements of this rule, the Medicaid substance use disorder program pays the lower of the following for Medicaid eligible members:

(a) the Medicaid substance use disorder program's usual and customary charge for services;

(b) the reimbursement methodologies described in ARM 37.85.212; or

(c) for items or services where no Resource Based Relative Value (RBRVS) or Medicare fee is available, the department's fee schedule.

(3) The allowable Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.105.

(4) The allowable non-Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.104.

(5) The allowable Medicaid substance use disorder reimbursement rate for case management services for members with substance use disorder is stated in the department's fee schedule provided in ARM 37.85.106.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.