BHDD Medicaid Services Provider Manual for SUD and Adult Mental Health, Effective May 12, 2023

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TABLE OF CONTENTS

Table of Contents
Section/
Subsection
Title/Content Issued/
Revised
   

Introduction

  
  001 Purpose 10/01/2022
  002 Definitions 10/01/2022

100

Section 1 - General Requirements

  
  105 Severe and Disabling Mental Illness 5/12/2023
  110 Substance Use Disorder 10/01/2022
  115 Assessments 10/01/2022
  120 Individualized Treatment Plans for Behavioral Health Treatment 10/01/2022
  130 Progress Notes 10/01/2022
  135 Continuing Care Plan 10/01/2022

200

Section 2 - Utilization Management
  205 Requesting a Prior Authorization – Non-Acute Services 10/01/2022
  206 Requesting Auto Authorization – Acute Services 10/01/2022
  206QA Auto-Authorization Quality Assurance 10/01/2022
  210 Requesting a Continued Stay Review – Non-Acute Services 10/01/2022
  215 Utilization Review Determinations and Notifications 5/12/2023
  220 Reconsideration Review Process 10/01/2022
  230 Integrated Service Delivery and Explanation of Concurrent Service 10/01/2022

300

Section 3 - Administrative Reviews

  
  305 Retrospective and Quality Reviews 10/01/2022
  310 Administrative Review, Fair Hearing, & Sanctions 5/12/2023

400

Section 4 - Medicaid Adult Mental Health Services

  
  405 MH Targeted Case Management (TCM) 10/01/2022
  410 Illness Management and Recovery Services (IMR) 10/01/2022
  415 Certified Behavioral Health Peer Support Services (CBHPSS) – Mental Health 5/12/2023
  420 Community Based Psychiatric Rehabilitation Support Services (CBPRS) 5/12/2023
  425 Mental Health (MH) Outpatient (OP) Therapy 10/01/2022
  430 Dialectical Behavior Therapy (DBT) 10/01/2022
  435 Day Treatment (Day TX) 10/01/2022
  440 Adult Foster Care (AFC) 10/01/2022
  445 Behavioral Health Group Home (BHGH) 5/12/2023
  450 Crisis Receiving and Stabilization Program 10/01/2022
  455 Montana Assertive Community Treatment (MACT) 5/12/2023
455QM Montana Assertive Community Treatment Quality Measures (MACT QM) (New) 10/01/2022
  460 Program of Assertive Community Treatment (PACT) 5/12/2023
  465 Acute Partial Hospital Program (PHP) 10/01/2022
  470 Acute Inpatient Hospital 10/01/2022
  475 Transcranial Magnetic Stimulation (TMS) 10/01/2022
  475QM Transcranial Magnetic Stimulation (TMS) QM 10/01/2022

500

Section 5 – Medicaid Substance Use Disorder (SUD) Services

  
  505 Specimen Collection for SUD Drug Testing 10/01/2022
  510 SUD Targeted Case Management 10/01/2022
514 Screening, Brief Intervention, and Referral to Treatment (SBIRT) 10/01/2022
  515 SUD Certified Behavioral Health Peer Support Services (CBHPSS) - Adult 5/12/2023
  520 SUD Outpatient (OP) Therapy (ASAM 1.0) 10/01/2022
  525 SUD Intensive Outpatient (IOP) Therapy (ASAM 2.1) 5/12/2023
  530 SUD Partial Hospitalization (ASAM 2.5) 10/01/2022
  535 SUD Clinically Managed Low-Intensity Residential (ASAM 3.1) 10/01/2022
536 SUD Withdrawal Management (ASAM 3.2) (New) 10/01/2022
537 SUD Clinically Managed Population‐specific High‐Intensity Residential (ASAM 3.3) Adult (New) 10/01/2022
  540 SUD Clinically Managed High-Intensity Residential (ASAM 3.5) 10/01/2022
  545 SUD Medically Monitored Intensive Inpatient (ASAM 3.7) 10/01/2022
  550 Medication Assisted Treatment (MAT) 10/01/2022