Montana § 53-21-1014 - Certified Community Behavioral Health Clinics -- Department Duties -- Reporting Requirement

§ 53-21-1014. Certified Community Behavioral Health Clinics -- Department Duties -- Reporting Requirement

Certified community behavioral health clinics -- department duties -- reporting requirement. (1) Subject to available funding, the department shall establish a program no later than October 1, 2026, for the implementation of certified community behavioral health clinics that meet the requirements of Public Law 113-93 and related federal regulations and guidance. (2) In determining the reimbursement rate for a certified community behavioral health clinic under the healthy Montana kids plan provided for under Title 53, chapter 4, part 11, and the medical assistance program provided for in Title 53, chapter 6, the department shall: (a) establish and execute clear criteria of the costs that are allowed and disallowed in the development of the encounter rate to be paid to a certified community behavioral health clinic under a prospective payment system; (b) establish and execute a detailed plan for analyzing cost reports submitted by providers seeking to become certified community behavioral health clinics to ensure that the encounter rate developed for the provider accurately reflects the actual costs of providing care and that disallowed costs are not included in the rate; and (c) rebase the rate in accordance with federal guidance, but no less frequently than every 2 years. (3) The department shall monitor and evaluate certified community behavioral health clinic services, outcomes, and impacts. Monitoring and evaluation efforts include: (a) developing and implementing a plan to reduce duplicative billing of services, fraud, waste, and abuse; (b) establishing quality measures for certified community behavioral health clinics and reviewing data on quality measures reported by each certified community behavioral health clinic; (c) establishing the circumstances under which a certified community behavioral health clinic would lose its certification; and (d) determining the costs to the medicaid program or other state-funded programs of providing behavioral health care services in a community or region before implementation of the certified community behavioral health clinic program and the costs, including any cost reductions, or providing those services after implementation of the certified community behavioral health clinic program. The costs must include payment for hospitalizations and emergency department visits. (4) The department shall provide quarterly updates in accordance with 5-11-210 to the children, families, health, and human services interim committee and the health and human services interim budget committee on: (a) the status of implementation of certified community behavioral health clinics; (b) the impacts of implementation on services for individuals with behavioral health needs; (c) patient-centered, quality health outcomes; (d) the percentage of high users of medicaid services who have reduced use of medicaid-funded services; (e) the community-level and state-level costs and cost savings related to certified community behavioral health clinics; and (f) any additional evaluation metrics required by the centers for medicare and medicaid services.