37.86.2207    EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT (EPSDT) SERVICES, REIMBURSEMENT

(1) Reimbursement for an EPSDT service, except as otherwise provided in this rule, is the lowest of the following:

(a) the provider's usual and customary charge for the service;

(b) the reimbursement determined in accordance with the methodologies provided in ARM 37.85.212 and 37.86.105;

(c) the department's Medicaid Mental Health Fee Schedule as provided in ARM 37.85.105(6); or

(d) for public agencies, cost based reimbursement as determined in accordance with OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments as established and approved by the department. The department adopts and incorporates by reference the OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments, as further amended May 14, 2004. A copy of OMB Circular A-87 may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) Reimbursement for nutrition, private duty nursing services, and orientation and mobility specialist services are specified in the department's fee schedule. The department adopts and incorporates by reference the department's Private Duty Nursing Services EPSDT Fee Schedule, the Nutrition EPSDT Fee Schedule, and the Orientation and Mobility Specialist EPSDT Fee Schedule as provided in ARM 37.85.105(3). Reimbursement for outpatient chemical dependency treatment is outlined in ARM 37.27.912.

(3) A service for which a fee is not set in or determinable through the EPSDT provider manual, ARM 37.85.212 or 37.86.105 is reimbursed at a fee negotiated in advance of the provision of the service. A service provided before there is a negotiated fee is reimbursed at an amount determined by the department.

(4) Reimbursements for school-based health related services are specified in the School-Based Health Service Fee Schedule. Rates are adjusted to reimburse these services at the federal medical assistance percentage (FMAP) rate.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1992 MAR p. 2788, Eff. 1/1/93; AMD, 1993 MAR p. 1540, Eff. 7/16/93; AMD, 1995 MAR p. 2501, Eff. 11/23/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1998 MAR p. 3219, Eff. 12/4/98; AMD, 1999 MAR p. 1806, Eff. 7/1/99; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 27, Eff. 1/12/01; EMERG, AMD, 2001 MAR p. 989, Eff. 6/08/01; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2041, Eff. 10/12/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; EMERG, AMD, 2002 MAR p. 1328, Eff. 4/26/02; AMD, 2002 MAR p. 1779, Eff. 6/28/02; EMERG, AMD, 2003 MAR p. 1316, Eff. 6/27/03; EMERG, AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2004 MAR p. 83, Eff. 1/1/04; AMD, 2005 MAR p. 1787, Eff. 9/23/05; AMD, 2006 MAR p. 1635, Eff. 6/23/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1488, Eff. 4/11/08; AMD, 2008 MAR p. 1980, Eff. 9/12/08; AMD, 2008 MAR p. 2673, Eff. 12/25/08; AMD, 2008 MAR p. 2360, Eff. 1/1/09; AMD, 2008 MAR p. 2674, Eff. 12/25/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2011 MAR p. 2824, Eff. 1/1/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13.