Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.90 - MENTAL HEALTH MEDICAID FUNDED 1115 AND 1915 WAIVERS
Subchapter 37.90.4 - Home and Community-Based Services Waiver for Adults With Severe and Disabling Mental Illness
Rule 37.90.408 - HOME AND COMMUNITY-BASED SERVICES FOR ADULTS WITH SEVERE AND DISABLING MENTAL ILLNESS: REIMBURSEMENT

(1) The department adopts and incorporates by reference the Medicaid Home and Community-Based Services for Adults with Severe and Disabling Mental Illness fee schedule. Unless otherwise provided for in rule, the provider reimbursement rate for waiver program services is stated in the department's fee schedule as provided in ARM 37.85.105(5)(b). These fees are calculated based on:

(2) Medicaid reimbursement for the SDMI HCBS waiver program will be the lesser of:

(3) The SDMI HCBS waiver program is the payor of last resort and will not reimburse a service that otherwise is or should be paid by another source.

(4) The SDMI HCBS waiver program will not reimburse for services provided to individuals of an enrolled member's household or family.

(5) All SDMI HCBS services, except for case management, must be prior authorized before delivery of services. Services that are delivered before prior authorization is received will not be approved and, if reimbursed, may be subject to repayment.