37.87.703    MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), COVERED SERVICES

(1) Mental health center services for youth with SED include:

(a) Community-Based Psychiatric Rehabilitation and Support (CBPRS) services as defined in ARM 37.87.702.

(b) Comprehensive school and community treatment in accordance with ARM Title 37, chapter 87, subchapter 18.

(c) Youth day treatment services as defined in ARM 37.87.702.

(d) In-training mental health professional services as defined in ARM 37.87.702. Services are subject to the same requirements that apply to licensed mental health professionals.

(e) Outpatient therapy services provided according to an individualized treatment plan and such services must include:

(i) psychotherapy services provided in accordance with the current edition of the American Medical Association's Current Procedural Terminology, Professional Edition, and codes approved by the department. The department adopts and incorporates by reference this manual;

(ii) family therapy, provided with or without the youth present, directed at the eligible youth's mental health needs and their impact on the family dynamics; and

(iii) individual and family therapy are targeted at reducing or eliminating symptoms or behaviors related to a youth's mental health diagnosis as specified in the treatment plan.

(f) Targeted case management (TCM) services as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(g) Mental health professional services, which include the professional component of physician or psychiatrist services covered in ARM 37.86.101, 37.86.104, and 37.86.105. Mental health professional services are subject to the following limitations:

(i) To the extent otherwise permitted by applicable Medicaid rules, such mental health professional services may be billed either by the mental health center as mental health center services or by the mental health professional under the applicable Medicaid category of service, but may not be billed as both mental health center services and mental health professional services.

(ii) Mental health professional services may be covered and reimbursed by Medicaid only if the mental health professional is enrolled as a provider and the services are provided according to the Medicaid rules and requirements applicable to the mental health professional's category of service.

(h) Home support services (HSS) and therapeutic foster care (TFC) as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

(i)  Mental health intensive outpatient therapy (IOP) as defined in the manual adopted and incorporated by reference in ARM 37.87.903.

History: 53-2-201, 53-6-101, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2020 MAR p. 691, Eff. 11/1/20; AMD, 2024 MAR p. 611, Eff. 3/23/24.