(1) The Montana Medicaid Program will reimburse providers of inpatient psychiatric services provided to a youth in a PRTF for each patient day as provided in these rules, effective December 31, 2013.

(2) 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.

(3) For in-state PRTFs, the Montana Medicaid Program will pay a provider for each Medicaid patient day, the following bundled per diem rate less any third party or other payments. The bundled per diem rate for in-state PRTF services is the lesser of:

(a) the amount specified in the department's Medicaid Youth Mental Health fee schedule, as adopted in ARM 37.85.105; or

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

(4) The bundled per diem rate for in-state PRTFs coverage includes the following services:

(a) a direct-care wage add-on through a contract with the department or in the bundled per diem rate, as applicable; effective July 1, 2013;

(b) services, therapies, and items related to treating the psychiatric condition of the youth;

(c) services provided by licensed psychologists, licensed clinical social workers, and licensed professional counselors;

(d) psychological testing;

(e) lab and pharmacy services related to treating the psychiatric condition of the youth; and

(f) supportive services necessary for daily living and safety.

(5) The bundled per diem rate for in-state PRTFs does not include the services listed in (a) through (d). The Montana Medicaid Program will reimburse enrolled providers directly for the following services:

(a) licensed physician, psychiatrist, and midlevel practitioner services;

(b) non-psychotropic medication and related lab services;

(c) adult mental health center evaluations for transition age youth 17 to 18, to determine whether or not they qualify for adult mental health services and have a severe and disabling mental illness; and

(d) Medicaid state plan ancillary services as directed by the PRTF physician, except targeted case management provided by either the PRTF or by outside providers. Medicaid state plan ancillary services must be stated in the plan of care of the youth.

(6) Out-of-state PRTFs will be reimbursed 50% of their usual and customary charges. Services that must be included in the out-of-state PRTFs usual and customary rate are outlined in (7).

(7) The bundled per diem rate for out-of-state PRTFs coverage includes the following services:

(a) all services, therapies, and items related to treating the condition of the youth;

(b) licensed physician, psychiatrist, and midlevel practitioner, psychologist, clinical social worker, and professional counselor services;

(c) psychological testing;

(d) lab and pharmacy services; and

(e) supportive services necessary for daily living and safety.

(8) The bundled per diem rate for out-of-state PRTFs does not include the services listed in (a) through (c). The Montana Medicaid Program will reimburse enrolled providers directly for the following services:

(a) up to 80 units of targeted case management services as defined in ARM 37.87.802 per PRTF stay;

(b) a clinical intake assessment by a licensed mental health center, with an endorsement to provide adult services, for transition age youth 17 to 18, to determine whether or not they have a severe and disabling mental illness and if they qualify for adult mental health services; and

(c) Medicaid state plan ancillary services, as directed by the PRTF physician, provided by the PRTF or by outside providers, enrolled as Montana Medicaid providers. Medicaid state plan ancillary services must be stated in the plan of care of the youth.

(9) The in-state and out-of-state PRTFs must maintain the medical records for Medicaid state plan ancillary services the youth receives.

(10) Providers must bill for PRTF services using the revenue codes designated by the department.

(11) Notice of the admission and discharge dates for the youth must be submitted to the department or its designee the day of admission or discharge. The department may impose a $100 charge against the facility for each instance where the department does not receive timely notification.