Issue 3 - the Montana Secretary of State Website

-426-
(b) providers must document in the case record that the individual has been
informed and if the individual has refused services.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-113, MCA
37.86.3506 CASE MANAGEMENT SERVICES FOR ADULTS WITH
SEVERE DISABLING MENTAL ILLNESS, SERVICE REQUIREMENTS
(1) through (8) remain as proposed.
(9) Case management services must be provided on a one-to-one basis, to
an individual by one case manager management provider.
(10) through (12) remain as proposed.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, MCA
37.86.3515 CASE MANAGEMENT SERVICES FOR ADULTS WITH
SEVERE DISABLING MENTAL ILLNESS, REIMBURSEMENT (1) Case
management services for adults with severe disabling mental illness will be
reimbursed on a fee per unit of service basis as follows:. For purposes of this rule, a
unit of service is a period of 15 minutes.
(a) the The department will pay the lower of the following for case
management services:
(i) the provider's actual submitted charge for services; or
(ii) the amount specified in the department's Medicaid fee schedule.
(b) a unit of service is a period of 15 minutes as follows:
(i) one unit of service is from 9 through 23 minutes;
(ii) two units of service are from 24 through 38 minutes;
(iii) three units of service are from 39 through 53 minutes;
(iv) four units of service are from 54 through 68 minutes;
(v) five units of service are from 69 through 83 minutes;
(vi) six units of service are from 84 through 98 minutes;
(vii) seven units of service are from 99 through 113 minutes; and
(viii) eight units of service are from 114 through 128 minutes.
(c) if a provider sees an eligible individual more than one time in a day, the
entire time spent with the individual that day should be totaled and billed once with
the correct number of units described in (b), which must be supported by
documentation requirements described in ARM 37.86.3305;
(d) providers are discouraged from consistently billing one unit of service for
an eight minute service, because one unit of service is meant to be a period of 15
minutes;
(e) reimbursement cannot be made to providers for time spent traveling to
provide a service or travel on behalf of an eligible individual for the following:
(i) direct delivery of a medical, educational, social, or other service to which
an eligible individual has been referred;
(ii) transportation for an eligible individual;
(iii) Medicaid eligibility determination and redetermination activities.
Montana Administrative Register 3-2/11/10