Montana Code 53-21-1402. Purpose — limitations
53-21-1402. Purpose — limitations. (1) (a) The purpose of this part is to establish a program through which enrolled providers may be reimbursed by the department when they provide mental health services during a 72-hour period to stabilize an adult who:
Terms Used In Montana Code 53-21-1402
- Adult: means an individual who is 18 years of age or older. See Montana Code 53-21-1401
- Crisis: means a serious, unexpected situation resulting from an individual's apparent mental illness in which the individual's symptoms are of sufficient severity, as determined by a mental health practitioner, to require immediate care to avoid:
(a)jeopardy to the life or health of the individual; or
(b)death or bodily harm to the individual or to others. See Montana Code 53-21-1401
- Crisis stabilization: means development and implementation of a short-term intervention to respond to a crisis in order to:
(a)reduce the severity of an individual's symptoms of mental illness; and
(b)attempt to prevent the individual from receiving services in a more restrictive environment. See Montana Code 53-21-1401
- Department: means the department of public health and human services provided for in 2-15-2201. See Montana Code 53-21-102
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
- Presumptive eligibility: means a period of up to 72 hours after an individual is found to be in crisis and during which the individual is presumed to be eligible for crisis stabilization services that will be reimbursed by the department. See Montana Code 53-21-1401
- services: means the services allowed under 53-21-1403. See Montana Code 53-21-1401
(i)is in a mental health crisis; and
(ii)is uninsured or whose insurance does not adequately cover the cost of the services.
(b)Reimbursement for services provided during a presumptive eligibility period is intended to reduce the need for the individual to receive more intensive services in a more restrictive setting.
(2)This part is not intended to establish an entitlement:
(a)for an individual to receive services under the program; or
(b)for a provider to be reimbursed for services delivered to an individual.
(3)The department may determine the duration of services to be reimbursed under the program and the types of providers who may receive reimbursement for services.
(4)The department or its designee may restrict reimbursement based on:
(a)the medical necessity of the services;
(b)availability of appropriate alternative services;
(c)the relative cost of services; or
(d)other relevant factors.
(5)(a) Subject to available funding, the department may suspend or eliminate reimbursement for services or otherwise limit services, benefits, or provider participation in the presumptive eligibility program.
(b)The department shall provide notice of changes to the program at least 10 days in advance of the date that the changes will be made by:
(i)publishing notice in Montana daily newspapers; and
(ii)providing written notice to crisis stabilization providers and other interested parties.