(1) For PRTF services provided on or after January 1, 2010, the Montana Medicaid program will pay a provider for each patient day as provided in these rules.

(a) Medicaid payment is not allowable for treatment or services provided in a PRTF that are not consistent with the definition of PRTF in ARM 37.87.1202 and unless all other applicable requirements are met.

(2) For inpatient psychiatric services provided by a PRTF in the state of Montana, the Montana Medicaid program will pay a provider, for each Medicaid patient day, a bundled per diem interim rate as specified in (3), less any third party or other payments. The interim rate is defined in ARM 37.87.1222.

(3) The statewide bundled per diem interim rate for inpatient psychiatric services is the lesser of:

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

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

(4) Out-of-state PRTF providers will be reimbursed 50% of their usual and customary charges. Reimbursement will include all Medicaid covered psychiatric, medical, and ancillary services provided in and by the PRTF consistent with ARM 37.87.1222. The usual and customary charge may not be more than twice the cost of providing the service.

(5) Emergency medical conditions treated by providers in a hospital emergency room outside the PRTF will not be included in the out-of-state PRTF's usual and customary rate, and must be billed by an enrolled provider directly to the Montana Medicaid program. Emergency medical services provided outside the PRTF will be reimbursed the prevailing Montana Medicaid rate using state funds. See ARM 37.87.1222 for the definition of emergency medical conditions, additional outside services that may be reimbursed using state funds at the prevailing Montana Medicaid rate and where services must be provided to be reimbursed.