53-6-198. (Effective on occurrence of contingency — temporary) Enhanced rate to increase access to in-state mental health services for high-risk children with multiagency service needs — reporting requirement — rulemaking. (1) In an effort to avoid the placement of high-risk children with multiservice agency needs in out-of-state residential treatment facilities, the department shall pay an enhanced medicaid reimbursement rate when an in-state provider of psychiatric residential treatment facility services provides treatment to a child who meets criteria established by the department. The criteria must be related to:

Terms Used In Montana Code 53-6-198

  • Department: means the department of public health and human services provided for in 2-15-2201. See Montana Code 53-6-155
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Medicaid: means the Montana medical assistance program established under Title 53, chapter 6. See Montana Code 53-6-155
  • Provider: means an individual, company, partnership, corporation, institution, facility, or other entity or business association that has enrolled or applied to enroll as a provider of services or items under the medical assistance program established under this part. See Montana Code 53-6-155

(a)the age of the child; or

(b)the acuity of the child’s treatment needs.

(2)(a) For the fiscal year beginning July 1, 2023, the reimbursement rate for psychiatric residential treatment facility services provided to a child meeting the age or acuity criteria established pursuant to this section is the higher of:

(i)133% of the rate in effect on July 1, 2022, for an in-state provider of the service; or

(ii)the rate adopted by the department for an in-state provider of the service for fiscal year 2024.

(b)The rate provided for in subsection (2)(a) must be increased in each subsequent fiscal year by the provider rate increase approved by the legislature for children’s mental health services for that fiscal year.

(3)The department shall annually determine, in consultation with providers of psychiatric residential treatment facility services, the criteria a child must meet for treatment to qualify for the enhanced reimbursement rate. The department shall notify providers of the determination no later than:

(a)May 15 for fiscal year 2024; and

(b)March 30 for subsequent fiscal years.

(4)The department shall adopt rules regarding the manner in which it will make the enhanced payments, including the frequency with which the payments will be made.

(5)(a) A provider that receives an enhanced reimbursement rate under this section shall:

(i)provide to the department a summary of the diagnoses, behaviors, and ages for the medicaid-eligible children receiving services from the provider in fiscal year 2023; and

(ii)report annually to the department on the diagnoses, behaviors, and ages of the medicaid-eligible children receiving services from the provider during the fiscal year in which the provider receives an enhanced reimbursement rate.

(b)The department shall report the information required under subsection (5)(a) to the legislature in accordance with 5-11-210.

(6)For the purposes of this section, the term “high-risk child with multiagency service needs” has the meaning provided in 52-2-302. (Terminates June 30, 2027–sec. 4, Ch. 586, L. 2023.)

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