Sec. 10.09.89.13. Limitations

A. Reimbursement shall be made by the Program only when all of the requirements of this chapter are met.

B. The Program may not reimburse for:

(1) Services that are:

(a) Provided by a member of the recipient’s immediate family or an individual who resides in the recipient’s home;

(b) Not preauthorized by the Department;

(c) Not medically necessary;

(d) Beyond the provider’s scope of practice;

(e) Not appropriately documented;

(f) Part of another service paid for by the State; or

(g) Provided without a valid required license or appropriate credentials as specified in this chapter;

(2) Completion of forms or reports;

(3) Broken or missed appointments;

(4) Time spent in travel by the provider to and from site of service, except when with the participant or the participant’s family; or

(5) Costs of travel by the provider to and from the site of service.

C. The Program may not reimburse more than the following:

(1) 1 session per day for out-of-home respite;

(2) 6 hours per day of community-based respite;

(3) 24 overnight units of respite annually;

(4) 2 types per day of expressive and experiential behavioral services; or

(5) 1 MCRS assessment for the development of the initial crisis plan.

D. Intensive in-home services may not be reimbursed for the same day of service or on the same day of service as:

(1) Partial hospitalization/day treatment;

(2) Mobile crisis response services; or

(3) Other family therapies.

E. Out-of-home respite and community-based respite services may not be reimbursed for the same day of service or on the same day of service as:

(1) Residential rehabilitation;

(2) Therapeutic behavioral services; or

(3) Any other public mental health system respite services.

F. Out-of-home respite and community-based respite services do not include on-going day care or before or after school programs.

G. Out-of-home respite and community based respite services may not be delivered to youth residing in Treatment Foster Care.

H. No more than 25 percent of the family support organization’s claims in a 30-day period for family peer support may be telephonic for a participant or the participant’s family.