(1) Services available through the program are reimbursed as provided in this rule.

(2) Program services are reimbursed at the lower of the following:

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

(b) the fees stated in Appendix A with an effective date of October 1, 2012 contained in the program's Home and Community-Based Services Bridge Waiver for Youth with Serious Emotional Disturbance Policy Manual dated October 1, 2012. The department adopts and incorporates by reference the policy manual which may be obtained through the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 North Sanders, P.O. Box 4210, Helena, MT 59604-4210 or at http://www.dphhs.mt.gov/mentalhealth/children/.

(3) Reimbursement is not made for a service that is otherwise available from another source.

(4) No copayment is imposed on services provided through the program.