Proposed BHDD Medicaid Services Provider Manual for SUD and Adult Mental Health, Effective October 1, 2022

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TABLE OF CONTENTS

Section/

Subsection

Title/Content

Issued/

Revised

   

Introduction

 
Concurrent Service 08/05/2022
  001 Purpose 08/05/2022
  002 Definitions 08/05/2022

100

Section 1 - General Requirements

 
  105 Severe and Disabling Mental Illness 08/05/2022
  110 Substance Use Disorder 08/05/2022
  115 Assessments 08/05/2022
  120 Individualized Treatment Plans for Behavioral Health Treatment 08/05/2022
  125 Screening, Brief intervention, and referral to Treatment (SBIRT) 08/05/2022
  130 Progress Notes 08/05/2022
  135 Individualized Discharge Summary 08/05/2022

200

Section 2 - Utilization Management

  205 Requesting a Prior Authorization – Non-Acute Services 08/05/2022
  206 Requesting Auto Authorization – Acute Services 08/05/2022
  206QA Auto-Authorization Quality Assurance 08/05/2022
  210 Requesting a Continued Stay Review – Non-Acute Services 08/05/2022
  215 Utilization Review Determinations and Notifications 08/05/2022
  220 Reconsideration Review Process 08/05/2022
  230 Integrated Service Delivery and Explanation of Concurrent Service 08/05/2022

300

Section 3 - Administrative Reviews

 
  305 Retrospective and Quality Reviews 08/05/2022
  310 Administrative Review, Fair Hearing, & Sanctions 08/05/2022

400

Section 4 - Medicaid Adult Mental Health Services

 
  405 MH Targeted Case Management (TCM) 08/05/2022
  410 Illness Management and Recovery Services (IMR) 08/05/2022
  415 Certified Behavioral Health Peer Support Services (CBHPSS) – Mental Health 08/05/2022
  420 Community Based Psychiatric Rehabilitation Support Services (CBPRS) 08/05/2022
  425 Mental Health (MH) Outpatient (OP) Therapy 08/05/2022
  430 Dialectical Behavior Therapy (DBT) 08/05/2022
  435 Day Treatment (Day TX) 08/05/2022
  440 Adult Foster Care (AFC) 08/05/2022
  445 Behavioral Health Group Home (BHGH) 08/05/2022
  450 Crisis Stabilization Program 08/05/2022
451 Crisis Receiving Program 08/05/2022
  455 Montana Assertive Community Treatment (MACT) 08/05/2022
455QM Montana Assertive Community Treatment Quality Measures (MACT QM) (New) 08/05/2022
  460 Program of Assertive Community Treatment (PACT) 08/05/2022
460QM Program of Assertive Community Treatment Quality Measures (PACT QM) (New) 08/05/2022
  465 Acute Partial Hospital Program (PHP) 08/05/2022
  470 Acute Inpatient Hospital 08/05/2022
    475 Transcranial Magnetic Stimulation (TMS) 08/05/2022
    475QM Transcranial Magnetic Stimulation (TMS) QM 08/05/2022

500

Section 5 – Medicaid Substance Use Disorder (SUD) Services

 
  505 SUD Drug Testing 08/05/2022
  510 SUD Targeted Case Management 08/05/2022
  515 SUD Certified Behavioral Health Peer Support Services (CBHPSS) - Adult 08/05/2022
  520 SUD Outpatient (OP) Therapy (ASAM 1.0) 08/05/2022
  525 SUD Intensive Outpatient (IOP) Therapy (ASAM 2.1) 08/05/2022
  530 SUD Partial Hospitalization (ASAM 2.5) 08/05/2022
  535 SUD Clinically Managed Low-Intensity Residential (ASAM 3.1) 08/05/2022
536 SUD Withdrawal Management (ASAM 3.2) (New) 08/05/2022
537 SUD Clinically Managed Population‐specific High‐Intensity Residential (ASAM 3.3) Adult (New) 08/05/2022
  540 SUD Clinically Managed High-Intensity Residential (ASAM 3.5) 08/05/2022
  545 SUD Medically Monitored Intensive Inpatient (ASAM 3.7) 08/05/2022
  550 Medication Assisted Treatment (MAT) 08/05/2022