53-21-702. Mental health managed care -- system elements. (1) The department of public health and human services shall develop a delivery system of mental health managed care from current providers or other entities that are able to provide administration or delivery of mental health services. A system of mental health managed care must include the following elements:
     (a) specific outcome and performance measures for the administration or delivery of a continuum of mental health services in order to provide contract compliance monitoring;
     (b) a fixed monetary or capitated payment mechanism;
     (c) a provision for local advisory councils that shall report to and meet on a regular basis with the advisory council provided for in 53-21-701(6);
     (d) provisions for appeal at the local level;
     (e) a requirement that each contractor that assumes any financial risk shall comply with the provisions of Title 53, chapter 6, part 7, for the medicaid portion of the program;
     (f) provisions that require documentation of evidence of the ability to provide services through an adequate provider network, as provided for in Title 33, chapter 36, and to comply with rules, regulations, and contract requirements;
     (g) a provision that, prior to final award of a contract, a successful bidder that serves adults shall enter into a contract with the Montana state hospital and the Montana mental health nursing care center that is consistent with 53-1-402, 53-1-413, and 90-7-312 and that includes financial incentives for the development and use of community-based services, rather than the use of the state institutional services;
     (h) the services that must be provided for medicaid-eligible individuals;
     (i) a provision to allow a spenddown by individuals to become eligible for medicaid;
     (j) the services, which may include a pharmacy benefit, that must be provided to nonmedicaid-eligible individuals whose income levels are below 200% of the federal poverty level as provided for in 53-6-131(10);
     (k) a provision that allows implementation of a specific sliding scale for premiums or copayments by nonmedicaid-eligible individuals taking into account income and percentage of poverty level;
     (l) a provision for children who need mental health services that are provided under substantive interagency agreements between state agencies responsible for addictive and mental disorders, foster care, children with developmental disabilities, special education, and juvenile corrections; and
     (m) requirements to ensure that the mental health managed care system will be operated in a cost-effective manner.
     (2) Services for nonmedicaid-eligible individuals may be more limited than those services provided to medicaid-eligible individuals.
     (3) The department shall contract with an independent professional consulting firm that is knowledgeable and experienced in developing managed mental health care systems. The department shall require, as part of the contract, that the consulting firm make regular reports to the legislative finance committee and any other appropriate legislative interim committee. Reports must be made at least every 6 months and must include information about the development and implementation of the new mental health managed care system.
     (4) The term of a mental health managed care contract may not be more than 5 years. The department may implement care-managed fee-for-service reimbursement to provide mental health services as otherwise permitted by law during the transition from a single statewide contract for mental health managed care.

     History: En. Sec. 7, Ch. 577, L. 1999.