AMDD Medicaid Services Provider Manual for SUD and Adult Mental Health, Effective April 1, 2021

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TABLE OF CONTENTS

Section/Subsection

Title/Content

Issued/Revised
   

Introduction

  
  001 Purpose 07/01/2020
  002 Definitions 07/01/2020

100

Section 1 - General Requirements

  
  105 Severe and Disabling Mental Illness 07/01/2020
  110 Substance Use Disorder 07/01/2020
  115 Assessments 07/01/2020
  120 Individualized Treatment Plans for Behavioral Health Treatment 10/01/2020
  125 Screening, Brief intervention, and referral to Treatment (SBIRT) 07/01/2020
  130 Progress Notes 07/01/2020
  135 Individualized Discharge Summary 07/01/2020

200

Section 2 - Utilization Management
  205 Requesting a Prior Authorization – Non-Acute Services 07/01/2020
  206 Requesting Auto Authorization – Acute Services 07/01/2020
  206a Auto-Authorization Quality Assurance 07/01/2020
  210 Requesting a Continued Stay Review – Non-Acute Services 07/01/2020
  215 Utilization Review Determinations and Notifications 07/01/2020
  220 Reconsideration Review Process 07/01/2020
  230 Integrated Service Delivery and Explanation of Concurrent Service 07/01/2020

300

Section 3 - Administrative Reviews

  
  305 Retrospective and Quality Reviews 07/01/2020
  310 Administrative Review, Fair Hearing, & Sanctions 07/01/2020

400

Section 4 - Medicaid Adult Mental Health Services

  
  405 MH Targeted Case Management (TCM) 07/01/2020
  410 Illness Management and Recovery Services (IMR) 07/01/2020
  415 Certified Behavioral Health Peer Support Services (CBHPSS) – Mental Health 07/01/2020
  420 Community Based Psychiatric Rehabilitation Support Services (CBPRS) 07/01/2020
  425 Mental Health (MH) Outpatient (OP) Therapy 04/01/2021
  430 Dialectical Behavior Therapy (DBT) 07/01/2020
  435 Day Treatment (Day TX) 07/01/2020
  440 Adult Foster Care (AFC) 07/01/2020
  445 Behavioral Health Group Home (BHGH) 07/01/2020
  450 Crisis Stabilization Program 07/01/2020
  455 Montana Assertive Community Treatment (MACT) 07/01/2020
  460 Program of Assertive Community Treatment (PACT) 10/01/2020
  465 Acute Partial Hospital Program (PHP) 07/01/2020
  470 Acute Inpatient Hospital 07/01/2020
   475 Transcranial Magnetic Stimulation (TMS) 10/01/2020 
   475a Transcranial Magnetic Stimulation (TMS) QM 10/01/2020

500

Section 5 – Medicaid Substance Use Disorder (SUD) Services

  
  505 SUD Drug Testing 07/01/2020
  510 SUD Targeted Case Management 07/01/2020
  515 SUD Certified Behavioral Health Peer Support Services (CBHPSS) - Adult 07/01/2020
  520 SUD Outpatient (OP) Therapy (ASAM 1.0) 07/01/2020
  525 SUD Intensive Outpatient (IOP) Therapy (ASAM 2.1) 07/01/2020
  530 SUD Partial Hospitalization (ASAM 2.5) 07/01/2020
  535 SUD Clinically Managed Low-Intensity Residential (ASAM 3.1) 07/01/2020
  540 SUD Clinically Managed High-Intensity Residential (ASAM 3.5) 07/01/2020
  545 SUD Medically Monitored Intensive Inpatient (ASAM 3.7) 07/01/2020
  550 Medication Assisted Treatment (MAT) 04/01/2021

 

Note: Please refer to AMDD Medicaid Services Provider Manual for SUD and Adult Mental Health for effective dates prior to 7-1-2020