ARM 37.87.1223. PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, REIMBURSEMENT

(1) For PRTF services provided on or after January 1, 2009, the Montana Medicaid program will pay a provider for each patient day as provided in these rules. (a) Medicaid payment is not allowable for treatment or services provided in a PRTF that are not consistent with the definition of PRTF in ARM 37.87.1202 and unless all other applicable requirements are met. (2) For inpatient psychiatric services provided by a PRTF in the state of Montana, the Montana Medicaid program will pay a provider, for each Medicaid patient day, a bundled per diem interim rate as specified in (3), less any third party or other payments. The interim rate is defined in ARM 37.87.1222. (3) The statewide bundled per diem interim rate for inpatient psychiatric services is the lesser of: (a) the amount specified in the department's Medicaid Mental Health and Mental Health Services Plan Fee Schedule, Individuals Under 18 Years of Age; or (b) the provider's usual and customary charges (billed charges). (4) Out-of-state PRTF providers who are not hospital-based will be reimbursed 50% of their usual and customary charges. Reimbursement will include all Medicaid covered psychiatric, medical, and ancillary services. Medical services are included as ancillary services. Ancillary services are defined in ARM 37.87.1222.