(1) Targeted case management (TCM) services for youth with SED will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is based on a 15-minute unit increment:
- (a) one unit of service is equal to 8 minutes but less than 23 minutes;
- (b) two units of service are greater than or equal to 23 minutes but less than 38 minutes;
- (c) three units of service are greater than or equal to 38 minutes but less than 53 minutes;
- (d) four units of service are greater than or equal to 53 minutes but less than 68 minutes;
- (e) five units of service are greater than or equal to 68 minutes but less than 83 minutes;
- (f) six units of service are greater than or equal to 83 minutes but less than 98 minutes;
- (g) seven units of service are greater than or equal to 98 minutes but less than 113 minutes; and
- (h) eight units of service are greater than or equal to 113 minutes but less than 128 minutes.
- (2) Targeted case management services 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 37.85.106.
(3) The department will pay providers of targeted case management services for youth with SED the lesser of:
- (a) the provider's actual submitted charge for services; or
- (b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.106.
- (4) Case managers may not bill for time spent writing progress notes. This activity is included in the rate for TCM services.
- (5) TCM services may be billed whether provided face-to-face or by telephone.
Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
History: NEW, 2009 MAR p. 266, Eff. 2/27/09; AMD, 2010 MAR p. 1512, Eff. 7/1/10; AMD, 2012 MAR p. 1273, Eff. 7/1/12; AMD, 2013 MAR p. 2153, Eff. 11/15/13; AMD, 2016 MAR p. 2063, Eff. 11/11/16; AMD, 2020 MAR p. 691, Eff. 11/1/20.