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Adam Meier, Director
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Home » Addictive and Mental Disorders » Forms and Applications

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Forms and Applications

Addictive & Mental Disorders Division

Forms and Applications

Medicaid Enrollment Application form for WASP and MHSP

 

Clinical Eligibility Form for WASP and MHSP

 

Applicant Checklist for WASP and MHSP

 

72-Hr Crisis Stabilization Form

 

Crisis Intervention and Response Form

 

Mental Health Forms:

  • Clinical Prior Authorization Form
  • Continued Stay Form
  • Serious Disabling Mental Illness (SDMI) and Level of Impairment Worksheet
  • Daily Limit Request
  • Addictive and Mental Disorders Division Data Corrections Request

Substance Use Disorder (SUD) Forms:

Substance Use Disorder (SUD) Prior Authorization Request Form for Residential and Inpatient Services

Substance Use Disorder (SUD) Continued Stay Request Form for Residential and Inpatient Services

Addictive & Mental Disorders

Contact AMDD

  • Staff Contact List

Suicide Information and Resources

Prevention Information and Resources

Crisis Systems Information and Resources

Utilization Management and Review Training

Documentation Training

AMDD Non-Medicaid Services Provider Manual for SUD and Adult Mental Health, Effective July 1, 2020

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

Services

  • Adult Mental Health Services
  • Substance Use Disorder Services
  • Mental Health Services Bureau Programs and Contacts
  • Children's Mental Health Services

Find Treatment

  • Treatment Services Locator

  • Map of Montana Substance Use Disorder Providers
  • Crisis Text Line
  • Montana Mental Health Centers
  • State Approved Substance Abuse Treatment Providers
  • NAMI-MT County Resource Guide
  • SAMHSA's National HelpLine

Facilities

  • Montana Chemical Dependency Center
  • Montana Mental Health Nursing Care Center
  • Montana State Hospital

More Information

  • Provider Information and Fee Schedules
  • Substance Use in Montana
  • For a copy of the SYNAR report, please contact Jackie Jandt at 444-9656
  • For Public Comment on the Mental Health and/or Substance Abuse Block Grant plan, please contact Dana Geary at 406-444-9657.
  • Interested Parties - Rule Making Notifications
  • Community Mental Health
    • Local Advisory Council (LAC) and Service Area Authority (SAA) Information
  • Forms and Applications
  • On-Line Payments
  • Online Resources

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