37.87.1013    THERAPEUTIC GROUP HOME (TGH), REIMBURSEMENT

(1) For the purpose of this subchapter, the following definitions apply:

(a) "Patient day" means a whole 24-hour period that a youth is present and receiving TGH 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.

(b) "Therapeutic intervention" is defined in ARM 37.97.102(23).

(c) "Therapy" is defined in ARM 37.97.102(26).

(2) The reimbursement rate for the therapeutic and rehabilitative portion of TGH or TGH with extraordinary needs aide (ENA) services is the lesser of (1)(a) or (b):

(a) the amount specified in the department's Medicaid Mental Health Fee Schedule as adopted in ARM 37.85.105; or

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

(3) The purpose of the therapeutic services in (1) is:

(a) to reduce the impairment of the mental disability of the youth and to improve the functional level of the youth;

(b) to alleviate the emotional disturbances;

(c) to reverse or change maladaptive patterns of behavior; and

(d) to encourage personal growth and development.

(4) TGHs are reimbursed a daily or patient day rate.

(5) TGH providers must use the procedure codes designated by the department, per the fee schedule in (1)(a) to be reimbursed for TGH, TGH with ENA, or TGH therapeutic home visit (THV) services.

(6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of TGH services.

(7) Reimbursement will be made to a provider for reserving a TGH bed while the youth is temporarily absent for a THV for a maximum of 14 patient days per state fiscal year.

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14.