HOME    SEARCH    ABOUT US    CONTACT US    HELP   
           
Rule: 37.34.1936 Prev     Up     Next    
Rule Title: PROVIDER REIMBURSEMENT
Add to My Favorites
Add to Favorites
Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: DEVELOPMENTAL DISABILITIES PROGRAM
Subchapter: Applied Behavior Analysis Services
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

Printer Friendly Version

37.34.1936    PROVIDER REIMBURSEMENT

(1) The department will pay providers of ABA services the lesser of: 

(a) the provider's actual submitted charge for services; or

(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.106.

(2) Claims must be submitted by, or on behalf of, a BCBA licensed by the State of Montana and enrolled as a Montana Medicaid provider.

(3) The provider may not:

(a) utilize Current Procedural Terminology (CPT) codes not approved by the department; or

(b) exceed the authorized units of service in an authorized 180 calendar day timespan.

(4) The department may review the medical necessity of services or items at any time, either before or after payment, in accordance with the provisions of ARM 37.85.410. If the department determines that services or items were not medically necessary, or otherwise not in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.

(5)  The department may not authorize provider's reimbursement retroactively for failure to submit timely, complete, and required documentation.

 

History: 53-2-201, 53-6-113, 53-21-703, MCA; IMP, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-21-701, 53-21-702, MCA; NEW, 2022 MAR p. 1850, Eff. 9/24/22.


 

 
MAR Notices Effective From Effective To History Notes
Home  |   Search  |   About Us  |   Contact Us  |   Help  |   Disclaimer  |   Privacy & Security