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

Universal Citation: MT Admin Rules 37.90.408

Current through Register Vol. 6, March 22, 2024

(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:

(a) the biennial legislative appropriation; and

(b) the estimated demand of covered services during the biennium.

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

(a) the provider's usual and customary charge for the service; or

(b) the rate established in the department's Medicaid fee schedule adopted and incorporated into ARM 37.85.105(5)(b).

(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 a member's household or family.

AUTH: 53-2-201, 53-6-402, MCA; IMP: 53-6-402, MCA

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