37.87.1803 COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM: REIMBURSEMENT
(1) Comprehensive school and community treatment (CSCT) services delivered by a licensed mental health center with an endorsement under ARM 37.106.1955 must be billed under the school district's provider number. Mental health services that are provided concurrently with CSCT are billed under the mental health center's provider number. Outpatient therapy codes may not be billed to Medicaid by CSCT staff concurrent with Medicaid for CSCT.
(2) CSCT services may be provided to:
(a) youth ages three through five who are receiving special education services from the public school in accordance with an individualized education program (IEP) under the Individuals with Disabilities Education Act (IDEA) or attending a preschool program offered through a public school; and
(b) youth ages six up to age 20, if they are enrolled in a public school.
(3) One team with two full-time employees will not be reimbursed for more than 720 billing units per team per month. Services must be billed for the month the service is provided. The licensed or in-training mental health professional must provide at least 40 percent of the units billed by the team each month. Billing units are calculated based on the sum total of minutes each professional spent with the youth per day.
(4) Up to 20 CSCT units per youth, per state fiscal year, may be billed for a intervention, assessment, and if necessary, referral to other services. There is no limit on the number of youth that may be served. These units must be billed as part of the 720 unit monthly team total.
(5) For a youth to qualify for more than 20 units of CSCT, a full clinical assessment is required and the youth must meet the SED criteria in ARM 37.87.903(8).
(6) The school district as a Medicaid provider of CSCT is subject to all Medicaid state and federal billing rules and regulations. The school district must:
(a) bill all available financial resources for support of services including third party insurance and parent payments, if applicable; and
(b) document services to support the Medicaid reimbursement received.
(7) The school district or the contracted provider must bill for youth not eligible for Medicaid, the school district may use a sliding-fee schedule.
(8) The school district must meet the certification of match requirements.
(9) The school district must provide to the department a copy of the certification of match documentation as required by the department, annually.
(10) Failure to provide documentation to the department in accordance with reporting requirements in (9) may result in:
(a) suspension of CSCT services or termination of the CSCT program for the following school year; or
(b) cost recovery.
History: 53-2-201, 53-6-113, MCA; IMP, 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2013 MAR p. 415, Eff. 7/1/13; AMD, 2014 MAR p. 1401, Eff. 6/27/14; AMD, 2016 MAR p. 1706, Eff. 9/24/16.