(1) The final rate for services provided to youths as that term is defined at ARM 37.89.103 for residential treatment facility providers located in the state of Montana is:

(a) the rate provided in the department's Medicaid Mental Health and Mental Health Services Plan Individuals Under 18 Years of Age Fee Schedule adopted in ARM 37.86.2207; and

(b) a direct care wage add-on as provided for in ARM 37.88.1111, if applicable.

(2) The rate in (1) will not be adjusted retrospectively based upon more recent cost data or inflation estimates. Cost settlements will not be performed.

(3) The rate is an all-inclusive bundled rate.

(4) Except as provided otherwise in this rule, the per diem payment rate covers and includes:

(a) all psychiatric services;

(b) all therapies required in the recipient's plan of care;

(c) all other services and items related to the psychiatric condition being treated that are provided while the recipient is admitted to the residential treatment facility;

(d) services provided by licensed psychologists, licensed clinical social workers, and licensed professional counselors; and

(e) lab and pharmacy services.

(5) These services must be reimbursed from the provider's all-inclusive rate except as provided otherwise in this rule, and are not separately billable.

(6) The professional component of physician services is separately billable according to the applicable rules governing billing for physician services.

(7) Services and items that are not related to the recipient's psychiatric condition being treated in the residential treatment facility and that are not provided by the residential treatment facility are separately billable in accordance with the applicable rules governing billing for the category of services or items.

(8) Reimbursement will be made to a residential treatment facility provider for reserving a bed while the recipient is temporarily absent only if:

(a) the recipient's plan of care documents the medical need for therapeutic home visits as part of a therapeutic plan to transition the recipient to a less restrictive level of care;

(b) the recipient is temporarily absent on a therapeutic home visit;

(c) the provider clearly documents staff contact and recipient achievements or regressions during and following the therapeutic home visit; and

(d) the recipient is absent from the provider's facility for no more than three patient days per absence.

(9) No more than 14 patient days per recipient in each rate year will be allowed for therapeutic home visits.

(10) Providers must bill for inpatient psychiatric services using the revenue codes designated by the department.