1. (1) Reimbursement for the therapeutic portion of home support services (HSS) and therapeutic foster care (TFC) services is the lesser of:

   1. (a) the amount specified in the department's fee schedule adopted in ARM 37.85.105; or
   2. (b) the provider's usual and customary charges.
2. (2) HSS and TFC providers must use the procedure codes designated by the department, in the fee schedule referred to in (1)(a) to be reimbursed for HSS and TFC.
3. (3) The TFC provider is reimbursed a daily rate. For TFC services, the department will reimburse the provider the daily rate for every day of a four-week period if the provider meets the minimum number of contacts as described in ARM 37.87.1410(6) during the four-week period.

4. (4) The HSS provider is reimbursed on a fee per unit of service basis. The two-hour weekly service requirement for HSS services must be met to be eligible for reimbursement. For purposes of this rule, a unit of service is based on a 15-minute unit increment. A unit of service is a period of 15 minutes as follows:

   1. (a) one unit of service is equal to 8 minutes but fewer than 23 minutes;
   2. (b) two units of service are greater than or equal to 23 minutes but fewer than 38 minutes;
   3. (c) three units of service are greater than or equal to 38 minutes but fewer than 53 minutes;
   4. (d) four units of service are greater than or equal to 53 minutes but fewer than 68 minutes;
   5. (e) five units of service are greater than or equal to 68 minutes but fewer than 83 minutes;
   6. (f) six units of service are greater than or equal to 83 minutes but fewer than 98 minutes;
   7. (g) seven units of service are greater than or equal to 98 minutes but fewer than 113 minutes; and
   8. (h) eight units of service are greater than or equal to 113 minutes but fewer than 128 minutes.
5. (5) HSS rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.105.
6. (6) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of HSS or TFC treatment, including when this service is delivered in a foster home.

Authorizing statute(s): 53-2-201, 53-6-113, MCA

Implementing statute(s): 53-2-201, 53-6-101, MCA

History: NEW, 2013 MAR p. 166, Eff. 2/1/13; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2018 MAR p. 458, Eff. 3/1/18; AMD, 2020 MAR p. 2435, Eff. 1/1/21.