Becoming a state approved program can have the following advantages:

1. Access to Substance Abuse Block Grant (SABG) funding. State approved programs can apply for SABG contract funds through a Request for Proposal (RFP) process each year (for non-Medicaid covered services and individuals 139-200% FPL)
2. Access to alcohol tax dollars. 20% of generated alcohol tax dollars are distributed to counties and only state approved programs included in a county plan and located in that county can receive those funds. Funds must be used for substance use disorder (SUD) prevention, treatment, and recovery services.
3. Per 61-8-1009, MCA, DUI education and assessments must be performed by an LAC at an approved program (currently this is inclusive of the state approved SUD providers)
4. State approve treatment programs can enroll in Montana Medicaid to bill for covered SUD services.

• BHDD Medicaid Provider Services Manuals for SUD and Adult Mental Health

When applying for state approval there are three qualifications to consider: Individual Providers, Facilities, and Prevention Provider. For all three, the Application and Supplement will need to be completed. Behavioral Health and Developmental Disabilities (BHDD) suggests reviewing ARM: 37.27 Chemical Dependency Program.

State Approved Substance Use Disorder Facilities (SUDF)

Facilities are organizations staffed with professionals from multiple disciplines that vary according to the American Society of Addiction Medicine (ASAM) Level of Care being provided. Facilities are staffed by a team of professionals that can be mobilized to offer substance use disorder (SUD) specialty services and multiple levels of care if the organization has the appropriate staffing at a given county location. Facilities receive an annual inspection through the Office of Inspector General (OIG) to ensure compliance with administrative rules.

What to expect:

• SUDF's must obtain their facility license from OIG before applying for state approval.
  • SUDF's can apply on their licensing site under:
    • Licensing System Resources
      • Be sure to review the webinar before applying on the Provider Portal.
• Upon the submission of the application, the department will respond within 30 days of receiving the application, the department will notify the applicant in writing of acceptance or denial of the application pursuant to SUDF- 37.27.106 (3).
• If the application and supporting documentation meet the application requirements, the department shall issue full-state approval. 
• SUDF's will receive a provisional state approval review from BHDD. The provider will be scheduled a documentation review with BHDD, either on-site or remotely. If the provider demonstrates compliance with administrative rules, a letter for full state approval will be issued.
  
  1. For further insight on what to expect from the documentation review, please review the following resources:
     1. BHDD Medicaid Provider Services Manual for SUD and Adult Mental Health
        1. Policy# 110-135
        2. Reviewed for services specified in Section 5 they have applied for on the state approval application. 
        3. ARM 37.27.120 (b)
           1. Refer to Provisional State Approval for more information

 SUDF's must uphold the standards set forth in BHDD Medicaid Services Provider Manual per their respective ARM:

• 37.27.106 STATE APPROVED PROGRAMS, SUBSTANCE USE DISORDER FACILITIES: 
  • (8) Approved facilities must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Manual.

State Approved Outpatient Treatment Providers

An outpatient treatment provider is a licensed addictions counselor that assumes the role of being the sole owner and operator. This provider offers outpatient services under the scope of their individual license to patients within their county. What sets this apart from a facility is the additional staff needed to offer SUD specialty services. Individual providers receive an annual inspection from BHDD to ensure compliance with administrative rules.

What to expect:

1. Upon the submission of the application, the department will respond within 30 days of receiving the application, the department will notify the applicant in writing of acceptance or denial of the application pursuant to each provider type:
   
   1. ARM 37.27.107 (3)
2. If written documents submitted to the department do not meet the requirements of these rules and regulations, the department shall notify the applicant in writing. The applicant shall have 30 days from date of notification to respond in writing to the content of the notice. If a response is not received within 30 days, the department may refuse to grant approval and shall notify the applicant in writing of the action taken.
3. If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely:
   1. ARM 37.27.107 (4) 
4. Individual Providers will receive a provisional state approval review from BHDD. The provider will be scheduled a documentation review with BHDD, either on-site or remotely. If the provider demonstrates compliance with administrative rules, a letter for full state approval will be issued.
   
   1. For further insight on what to expect from the documentation review, please review the following resources:
      1. BHDD Medicaid Provider Services Manual for SUD and Adult Mental Health
         1. Policy# 110-135 & 520
         2. ARM 37.27.120 (b)
            1. Refer to Provisional State Approval for more information
5. Once full state approval has been granted, providers delivering SUD treatment services can enroll in MT Medicaid. 

Individual Treatment Providers will be reviewed by the department annually to ensure quality standards are being met for state approval and  BHDD Medicaid Services Provider Manual per:

• ARM 37.27.107 STATE APPROVED PROGRAMS, INDIVIDUAL OUTPATIENT TREATMENT PROVIDERS
  • (9) Approved providers must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Services Provider Manual.

State Approved Prevention Providers

Prevention Providers offer provide prevention and early intervention services as described by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. Prevention providers receive an annual inspection from BHDD to ensure compliance with administrative rules. Prevention Providers have the option to offer Early Intervention services, which includes DUI and MIP courses.

What to expect:

• Upon the submission of the application, the department will respond within 30 days of receiving the application, the department will notify the applicant in writing of acceptance or denial of the application pursuant to each provider type:
  • ARM 37.27.105 (3)
• If written documents submitted to the department do not meet the requirements of these rules and regulations, the department shall notify the applicant in writing. The applicant shall have 30 days from date of notification to respond in writing to the content of the notice. If a response is not received within 30 days, the department may refuse to grant approval and shall notify the applicant in writing of the action taken.
• If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely: 
  • Prevention Providers offering Early Intervention services-  ARM 37.27.105 (4).
• Prevention Providers offering Early Intervention services will receive a with initial review from BHDD for full-state approval inspection. The provider will be scheduled a documentation review with BHDD, either on-site or remotely. If the provider demonstrates compliance with administrative rules, a letter for full state approval will be issued.
  
  • For further insight on what to expect from the documentation review, please review the following resources:
    
    • BHDD Medicaid Provider Services Manual for SUD and Adult Mental Health
      • Policy# 110, 115, 130, and 135
      • ARM 37.27 Subchapter 5
• Once full state approval has been granted, providers delivering SUD treatment services can enroll in MT Medicaid. 

Prevention Providers will be reviewed by the department annually to ensure quality standards are being met for state approval and  BHDD Medicaid Services Provider Manual per:

• ARM 37.27.105 STATE APPROVED PROGRAMS, PREVENTION PROVIDERS, REQUIREMENTS
  • (9) Approved providers must follow the American Society of Addiction Medicine (ASAM) Criteria in the provision of early intervention services and adhere to requirements outlined in the BHDD Medicaid Services Provider Manual for SUD and Adult Mental Health

Treatment programs and providers applying for state approval for the first time are required to undergo Provisional State Approval. Provisional State Approval may be granted for a period of up to six months; however, the review and approval process is not intended to require the full duration of this timeframe. Provisional State Approval allows programs to begin providing state-approved substance use disorder treatment services in accordance with ASAM criteria during the start-up phase. This approval period provides programs the opportunity to establish operations, implement required documentation practices, and demonstrate compliance with applicable state requirements, ASAM criteria, and the BHDD Medicaid Manual prior to full approval.

The intent of Provisional State Approval is to ensure that programs and providers meet the requirements outlined in the following Administrative Rules of Montana (ARM):

ARM 37.27.106 State Approved Programs, Substance Use Disorder Facilites

• (9) Approved facilities must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Manual.

ARM 37.27.107 State Approved Programs, Individual Treatment Providers

• (9) Approved providers must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Manual.

Note: BHDD continues to adhere to the ASAM 3rd Edition Criteria until policies are formally updated.

The documentation review consists of the following:

• Annual Program Review per ARM 37.27.120:
  • Demographics
  • No Shows
  • Wait Times
  • Abstinence and reduction of the use of substances
  • Involvement with the criminal justice system
  • Stable employment
  • Housing stability
  • Retention in services
  • Perception of care
  • Social connectedness
  • Use of evidence-based practices.
• Records should include:
  • Intake Paperwork
  • Assessment
  • Treatment Plan(s)
  • Progress Notes
    • Group
    • Individual
    • Care/Case Management
  • Continuing Care Plan/Discharge Plan

• File Example
  • Section 1: Intake Paperwork
  • Section 2: Assessment
  • Section 3: Treatment Plans (organized by date of initial service first)
  • Section 4: Progress Notes (organized by date of initial service first)
    • Individual
    • Group
    • Case Management
  • Section 5: Continuing Care Plan

All documentation submitted for review will be evaluated based on the standards set forth in the ASAM Criteria and the BHDD Medicaid Manual. The department reserves the right to return records that are not organized in accordance with these requirements. If a newly established program or provider does not yet have completed records available for review, the program or provider may notify the Program Officer and request approval to submit sample or mock records for the purposes of initial provisional state approval. Mock or sample records are accepted only during the provisional approval phase. Providers must demonstrate compliance through submission of actual client records as part of annual state approval and any subsequent reviews.

Following completion of the documentation review, the Program Officer will contact the program or provider to discuss the review findings. This process is not intended to serve as a pass or fail determination. Rather, it is designed to support a collaborative discussion regarding documentation practices. The discussion will focus on identifying strengths and areas for improvement to support adherence to ASAM 3rd Edition criteria and the BHDD Medicaid Manual. Feedback provided through this process is intended to support continuous quality improvement and strengthen ongoing compliance.

Following successful completion of Provisional State Approval, treatment programs and providers may be considered for Full State Approval. Full State Approval is granted upon demonstration of compliance with applicable ASAM criteria and the BHDD Medicaid Manual. As part of the full approval process, programs must submit actual client records for review to verify implementation of required clinical, administrative, and documentation standards. Full State Approval is subject to annual review and continued adherence to ASAM requirements and the BHDD Medicaid Manual.

Important Note

Being granted full state approval from the department does not mean a program and/or provider is automatically enrolled into Medicaid. They must go enroll on MPATH Provider Services. A separate department handles the enrollments: Conduent. Their contact information is the following:

• Provider Relations (In/Out of state): 1 (800) 624-3958
• Provider Relations (Helena): (406) 442-1837
• Provider Relations (Fax): (406) 442-4402
• mtprhelpdesk@conduent.com

• Facility State Approval Application
• Facility State Approval Application Supplement

ALL DOCUMENTS MUST BE INCLUDED:

• State Approval Application
  • List of all Applicant site addresses and phone numbers
  • Copy of Health Care Facility License
• State Approval Application Supplement
  • Local Need Narrative
    • please read instructions on page 5 of the application supplement

Once the application has been completed, please send to:

Cody Magpie LAC
Substance Use Disorder Program Officer
bhddapprovalapps@mt.gov

The Program Officer can be reached at: 406-444-9582 for any questions, concerns, and/or guidance regarding the approval process.

• Individual Provider State Approval Application
• Individual Provider State Approval Application Supplement
• Individual Provider State Approval Review Form

ALL DOCUMENTS MUST BE INCLUDED:

• State Approval Application (both pages filled out and signed on the last page)
  • Copy of certificate of general liability insurance and professional liability
  • Policies and procedures that address the following:
    • Program organization and management (ARM 37.27.120);
      • Individual LAC assumes sole legal responsibility. LAC private
        office are not a facility and cannot bill for licensure candidates or
        other staff.
    • Acceptance of persons for treatment (ARM 37.27.115);
    • Client rights (ARM 37.27.116);
    • Communicable Disease Control (ARM 37.27.118)
    • Confidentiality (ARM 37.27.117 & 42 CFR Part 2);
    • Targeted populations (45 CFR 96.126 – 131)
    • Abuse or Neglect (ARM 37.27.119); and
    • Detailed description of program services.
• State Approval Application Supplement (first three pages filled out)
  • Local Need Narrative on last page or separate document.
    • please read instructions on page 5 of the application supplement

Once the application has been completed, please send to:

Cody Magpie LAC
Substance Use Disorder Program Officer
bhddapprovalapps@mt.gov

The Program Officer can be reached at: 406-444-9582 for any questions, concerns, and/or guidance regarding the approval process.

• Prevention Provider State Approval Application
• Prevention Provider State Approval Supplement

ALL DOCUMENTS MUST BE INCLUDED:

• State Approval Application
  • Copy of program self-evaluation ARM 37.27.120(1)(b)
  • Only If Offering Early Intervention Services:
    •  37.27.116 CLIENTS RIGHTS
    • 37.27.117 CONFIDENTIALITY
    • 37.27.118 COMMUNICABLE DISEASE CONTROL
    • 37.27.119 ABUSE OR NEGLECT
• State Approval Application Supplement
  • Local Need Narrative
    • please read instructions on page 5 of the application supplement
  • Only if offering Early Intervention Services:
    • Fill out Page 1: Projected Services Section

Once the application has been completed, please send to:

Cody Magpie LAC
Substance Use Disorder Program Officer
bhddapprovalapps@mt.gov

The Program Officer can be reached at: 406-444-9582 for any questions, concerns, and/or guidance regarding the approval process.