Montana Code 53-21-1404. Claims and reimbursement — exceptions
53-21-1404. Claims and reimbursement — exceptions. (1) The department shall adopt and make available a fee schedule for crisis stabilization services.
Terms Used In Montana Code 53-21-1404
- 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
- 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
(2)Claims for crisis stabilization services provided pursuant to this part must be submitted to the department as provided by rule.
(3)Providers shall accept the amounts payable under this section as payment in full for services delivered to eligible individuals during the presumptive eligibility period.
(4)Services delivered to an individual in crisis may not be reimbursed if:
(a)the services delivered were not approved for reimbursement by the department; or
(b)the provider is not enrolled with the department.