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Montana Behavioral Health

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Welcome

Welcome to the Magellan Medicaid Administration, Inc. of Montana Web site. This site is designated to assist with utilization management and prior authorization of services as required by the Medicaid program. You'll also find information about the new online PA system you'll use to submit requests and look up statuses. Please continue to check this Web site for updates (forms, Web application, etc.) and system availability.

View AllWeb Announcements

October 2013

Changes to Prior Authorization Requirements for Therapeutic Youth Group Homes – Additional Information

Please click here to read this DPHHS Montana Health Care Programs Notice issued on September 27, 2013

September 2013

Important Changes to Contract with Magellan Medicaid Administration (MMA)

Please click here to read this DPHHS Montana Health Care Programs Notice issued on September 24, 2013


Important Changes to Contract with Magellan Medicaid Administration (MMA)

Please click here to read this DPHHS Montana Health Care Programs Notice issued on August 31, 2013

April 2013

Important Psychiatric Residential Treatment Facility (PRTF) Reminders

Please click here to read this DPHHS Montana Health Care Programs Notice issued on April 02, 2013

February 2013

Important Psychiatric Residential Treatment Facility (PRTF) Requirements

Please click here to read this DPHHS Montana Health Care Programs Notice issued on February 19, 2013

October 2012

Updates for Montana Youth Services Providers

  • Revised Children’s Mental Health Bureau’s Provider Manual and Clinical Guidelines for Utilization Management (UR Manual) – effective 10-1-12
  • Revised Appeal & Administrative Review (AR) Process in UR Manual
  • The appeal and administrative review request language in the notification letters and form will be revised to reflect changes in 10-1-12 UR Manual. Until the letters are changed, the timelines in the UR Manual apply.
  • Revised Prior Authorization (PA) and Continued Stay Request (CSR) forms recommend a licensed or in-training mental health professional complete the form. However, this is not a requirement. If the credentials of the person completing the form are not on the form, indicate “Other.”
  • The following revised PA forms require the provider to substantiate the youth’s SED diagnosis and functional impairment.
    • Psychiatric Residential Treatment Facility (PRTF)
    • Partial Hospital (PHP) Program
    • Therapeutic Group Home (TGH)
  • The Permanency Level Therapeutic Foster Care PA form was not changed, however, the provider must substantiate the youth has an SED in the “Reason for Admission” section.
  • The PRTF and PHP PA web-based forms have not been updated. Substantiate the youth’s SED diagnosis and functional impairment in the “Reason for Admission” section.
  • There are additional requirements for the ICPC to place youth in out-of-state PRTF and TGH facilities, see Provider Notice on MTMedicaid.org dated 9-26-12.

November 2011

Psychiatric Residential Treatment Facilities are required to contact the Magellan Medicaid Administration’s Regional Care Coordinator (RCC) to participate in the youth’s treatment team meetings or the youth’s therapist is required to contact the RCC to update them on the youth’s treatment at a minimum of every 30 days.
Click here to view the RCC contact information.

August 2011

Effective 08/12/2011, the maximum number of authorized days for Therapeutic Group Home services, procedure code S 5145 will be 120 for both Initial and Continued Stay Reviews.

July 2011

Effective 07/01/2011, Targeted Youth Case management services do not require Prior authorization or Unscheduled Revision reviews.

January 2011

Children’s Mental Health Bureau has effected the following changes in CPT Codes for therapeutic group home, therapeutic family care, and therapeutic foster care:

  • Effective 01/15/2011 Therapeutic group home use procedure code S5145 for prior authorization and continued stay requests.
  • Effective 01/15/2011 Moderate level therapeutic family care to use procedure code H2020 for prior authorization and continued stay requests.
  • Effective 01/15/2011 Moderate level therapeutic foster care use procedure code S5145 and modifier HR for prior authorization and continued stay requests.
  • Effective 01/15/2011 Permanency level therapeutic foster care use procedure code S5145 and modifier HE for prior authorization and continued stay requests.
  • Effective 01/15/2011 Community-based psychiatric rehabilitation and support (CBPRS) services do not require prior authorization when provided on the same day as CSCT, Day Treatment or partial hospital services, if CBPRS is provided before or after program hours. This includes both individual and group CBPRS.