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Rule Title: MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, AUTHORIZATION REQUIREMENTS
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Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: CHILDREN'S MENTAL HEALTH SERVICES
Subchapter: Medicaid Mental Health Services for Youth
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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37.87.903    MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, AUTHORIZATION REQUIREMENTS

(1) The department will not reimburse providers for two services that duplicate one another on the same day.

(2) Medicaid mental health services for youth requiring approval prior to treatment, prior authorization, or continued stay authorization is reimbursed only if the youth has been determined to have a serious emotional disturbance defined in the Manual adopted and incorporated by reference in (8), which has been verified by the department or its utilization review contractor.

(3) Youth are not required to have a serious emotional disturbance to receive the following outpatient therapy services:

(a) the first 10 sessions of individual, family, or both outpatient therapies per state fiscal year. Group outpatient therapy is not included in the 10-session limit; and

(b) group outpatient therapy.

(4) The department may waive a requirement for prior authorization or continued authorization when the provider submits documentation that:

(a) there was a clinical reason why the request for prior authorization or continued authorization could not be made at the required time, and the provider submitted a subsequent authorization request within ten business days; or

(b) a timely request for prior authorization or continued authorization was not possible because of an equipment failure or malfunction of the department or its designee that prevented the transmittal of the request at the required time and the provider submitted a subsequent authorization request within ten business days.

(5) Computing the time for any request provided for in this subchapter includes weekends and holidays. If a deadline falls on a weekend or holiday, the deadline is the next business day.

(6) If the department finds exceptional circumstances that reasonably justify a provider's failure to timely request prior authorization or continued authorization, it may extend the deadline for meeting the requirement.

(7) In addition to the requirements contained in rule, the department has developed and published a provider manual entitled Children's Mental Health Bureau, Medicaid Services Provider Manual (Manual), dated July 1, 2018, for the purpose of implementing requirements for utilization management. The department adopts and incorporates by reference the Children's Mental Health Bureau, Medicaid Services Provider Manual, dated July 1, 2018. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 or at http://dphhs.mt.gov/dsd/CMB/Manuals.aspx.

(8) 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 in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.

(9) The department or its designee may require providers to report outcome data or measures regarding mental health services, as determined in consultation with providers and interested persons.

 

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15; AMD, 2016 MAR p. 1393, Eff. 8/6/16; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 1116, Eff. 7/1/18.


 

 
MAR Notices Effective From Effective To History Notes
37-838 7/1/2018 Current History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15; AMD, 2016 MAR p. 1393, Eff. 8/6/16; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2018 MAR p. 1116, Eff. 7/1/18.
37-828 3/1/2018 7/1/2018 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15; AMD, 2016 MAR p. 1393, Eff. 8/6/16; AMD, 2018 MAR p. 458, Eff. 3/1/18.
37-751 8/6/2016 3/1/2018 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15; AMD, 2016 MAR p. 1393, Eff. 8/6/16.
37-719 10/1/2015 8/6/2016 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14; AMD, 2015 MAR p. 1500, Eff. 10/1/15.
37-679 9/19/2014 10/1/2015 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2014 MAR p. 2147, Eff. 9/19/14.
37-648 11/15/2013 9/19/2014 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13
37-617 2/1/2013 11/15/2013 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12; AMD, 2013 MAR p. 164, Eff. 2/1/13.
37-597 10/12/2012 2/1/2013 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11; AMD, 2012 MAR p. 2086, Eff. 10/12/12.
37-543 8/26/2011 10/12/2012 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11; AMD, 2011 MAR p. 1708, Eff. 8/26/11.
37-533 6/24/2011 8/26/2011 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11; AMD, 2011 MAR p. 1154, Eff. 6/24/11.
37-518 1/15/2011 6/24/2011 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2011 MAR p. 49, Eff. 1/15/11.
37-503 7/1/2010 1/15/2011 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10.
37-460 2/27/2009 7/1/2010 History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 266, Eff. 2/27/09.
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