53-21-1402. Purpose -- limitations.
264 words·~1 min read·
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53-21-1402 . Purpose -- limitations.
(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:
(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.
(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.