37.86.4010    TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, REIMBURSEMENT

(1) TCM services for substance use disorders will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is a period of 15 minutes.

(2) The department may, in its discretion, designate a single provider to provide targeted case management services in a designated geographical region. Any provider designated as the sole case management provider for a designated geographical region must, as a condition of such designation, agree to serve the entire designated geographical region.

(3) The provider reimbursement rate for case management services for substance use disorders is stated in the department's fee schedule provided in ARM 37.85.105(5).

(4) The department will pay the lower of the following for TCM services:

(a) the provider's actual submitted charge for services; or

(b) the amount specified in the State Approved Chemical Dependency Program Manual.

(5) Providers may bill TCM services for persons transitioning from an institution to a community setting as follows:

(a) With a covered inpatient stay, the person receiving services may be eligible for TCM services during the last 14 days prior to discharge to the community.

(b) TCM activities must be coordinated with and not duplicate inpatient discharge planning.

(c) Amount, duration, and scope of the case management activities will be documented in a person's plan of care including activities prior to and post-discharge, to facilitate a successful transition to community living.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-113, MCA; NEW, 2013 MAR p. 269, Eff. 3/1/13; AMD, 2013 MAR p. 1111, Eff. 7/1/13.