(1) Reimbursement for the therapeutic portion of therapeutic family care (TFC) and therapeutic foster care (TFOC) services is the lesser of (1)(a) or (b):

(a) the amount specified in the department's Medicaid Mental Health and Mental Health Services Plan, Individuals Under 18 Years of Age Fee Schedule adopted in ARM 37.87.901; or

(b) the provider's usual and customary charges.

(2) TFC and TFOC providers must use the procedure codes designated by the department, per the fee schedule in (1)(a) to be reimbursed for TFC, TFOC, and TFOC moderate level THV services.

(3) TFC and TFOC providers are reimbursed a daily or patient day rate. Patient day means a whole 24-hour period that a youth is present and receiving TFC or TFOC services. Even though a youth may not be present for a whole 24-hour period, the day of admission is a patient day. The day of discharge is not a patient day.

(4) Reimbursement will be made to a provider for reserving a moderate level TFOC bed while the youth is temporarily absent for a THV if:

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

(b) the youth is temporarily absent on a THV;

(c) the provider clearly documents staff contact and youth achievements or regressions during and following the THV; and

(d) the youth is absent from the moderate level TFOC home for no more than three patient days per THV, unless additional days are authorized by the department.

(5) No more than 14 patient days per youth in each state fiscal year will be allowed for moderate level TFOC THVs.

(6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of TFC or TFOC treatment.