Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.30 - Outpatient Hospital Services
Rule 37.86.3022 - OUTPATIENT HOSPITAL SERVICES, PARTIAL HOSPITALIZATION SERVICES

(1) Partial hospitalization services will be reimbursed on a prospective per diem rate which shall be the lesser of the amount specified in the department's Medicaid Mental Health Fee Schedule or the provider's usual and customary charges (billed charges). The per diem rates specified in the department's Medicaid Mental Health Fee Schedule are bundled prospective per diem rates for full-day programs and half-day programs, as defined in ARM 37.86.3001. The bundled prospective per diem rate includes all outpatient psychiatric and psychological treatments and services, laboratory and imaging services, drugs, biologicals, supplies, equipment, therapies, nurses, social workers, psychologists, licensed professional counselors, and other outpatient services, that are part of or incident to the partial hospitalization program, except as provided in the department's Medicaid Mental Health Fee Schedule.

(2) The professional component of physician services, including psychiatrist services, is separately billable according to the applicable department rules governing billing for physician services.