37.90.408 HOME AND COMMUNITY-BASED SERVICES FOR ADULTS WITH SEVERE DISABLING MENTAL ILLNESS: REIMBURSEMENT
(1) The department adopts and incorporates by reference the Medicaid Home and Community-Based Services for Adults With Severe Disabling Mental Illness Fee Schedule. The provider reimbursement rate for a covered service for Home and Community-Based Services for Adults with Severe Disabling Mental Illness, unless provided otherwise in this rule, is stated in the department's fee schedule as provided in ARM 37.85.105(5)(b). These fees are calculated based on:
(a) the biennial legislative appropriation; and
(b) the estimated demand of covered services during the biennium.
(2) The following services are reimbursed as provided in (3):
(b) adult day health;
(d) personal emergency response systems;
(f) psycho-social consultation;
(h) dietetic services;
(i) specially trained attendant care;
(j) substance use related disorder services;
(k) supported living;
(l) adult residential care;
(m) respite care not provided by a nursing facility;
(n) nonmedical transportation;
(o) specialized medical equipment and supplies;
(p) illness management and recovery services;
(q) Wellness Recovery Action Plan (WRAP);
(r) community transition service;
(s) health and wellness; and
(t) pain and symptom management.
(3) The services specified in (2) are, except as otherwise provided in (4), reimbursed at the lower of the following:
(a) the provider’s usual and customary charge for the service; or
(b) the rate negotiated with the provider by the case management team up to the department’s maximum allowable fee.
(4) The services specified in (2) are reimbursed as provided in (3) except that reimbursement for components of those services that are incorporated by specific cross reference from the general Medicaid program may only be reimbursed in accordance with the reimbursement methodology applicable to the component service of the general Medicaid program.
(5) The following services are reimbursed in accordance with the referenced provisions governing reimbursement of those services through the general Medicaid program:
(a) personal assistance as provided at ARM 37.40.1105; and
(b) outpatient occupational therapy as provided at ARM 37.86.610.
(6) Case management services are reimbursed, as established by contractual terms, on either a per diem or hourly rate.
(7) Respite care services provided by a nursing facility are reimbursed at the rate established for the facility in accordance with ARM Title 37, chapter 40, subchapter 3.
(8) Reimbursement will not be paid for a service that is otherwise available from another source.
(9) No copayment is imposed on services provided through the program but persons are responsible for copayment on other services reimbursed with Medicaid monies.
(10) Reimbursement is not available for the provision of services to other members of a person’s household or family unless specifically provided for in these rules.
History: 53-2-201, 53-6-402, MCA; IMP, 53-6-402, MCA; NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2011 MAR p. 1394, Eff. 7/29/11; AMD, 2012 MAR p. 1265, Eff. 7/1/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13; AMD, 2018 MAR p. 1116, Eff. 7/1/18.