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    v1.0.28
    OpenPayerPolicy UpdatesPsychiatry/Behavioral HealthMontana DPHHS GBMI Group Home Coverage | OpenPayer
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    CurrentMontana Department of Public Health & Human ServicesPolicy N/A

    GBMI Group Home Services Coverage Criteria

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    Policy governs Group Home services for individuals found Guilty But Mentally Ill (GBMI) who are sentenced to the custody of the Montana DPHHS Director and placed in approved GBMI group home settings; it describes eligible individuals, provider types, and minimum service expectations.

    Policy Summary
    PayerMontana Department of Public Health & Human Services
    PolicyGBMI Group Home Services Coverage Criteria
    Policy CodePolicy N/A
    Change TypeMinor review — no material changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionEnsure placement is to an authorized GBMI provider (Mental Health Center with forensic group home endorsement or the Montana State Hospital) and document judicial sentence and appropriateness for GBMI placement.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2 hrsmin treatment/day
    7 days/wkmin frequency
    MH Centers, MSHauthorized providers
    4ongoing services listed

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    GBMI Group Home Coverage Criteria

    GBMI Group Home Coverage Criteria

    Covered when ALL of the following are met

    Judicial custody: Individual has been sentenced to the custody of the Director of DPHHS by a judge following a conviction and a finding of mental disorder or developmental disability at the time of the offense

    [[chunk 1]]

    Placement appropriateness: Individual has been determined appropriate for release to a GBMI group home setting

    [[chunk 1]]

    Provider type: Placement is to an authorized GBMI provider (Mental Health Center with forensic group home endorsement or Montana State Hospital)

    [[chunk 2]]

    Service minimums: Group home provides a minimum of two hours of treatment per day, seven days a week>=2 hours/day and 7 days/week

    [[chunk 3]]

    Individuals are ineligible for GBMI group home services unless they have been judicially sentenced to the custody of the Director of DPHHS following a conviction with a finding of mental disorder or developmental disability at the time of the offense and have been determined appropriate for release to a GBMI group home setting. Placement must be expressly for individuals sentenced to DPHHS custody and approved for GBMI group home placement; absence of either the judicial custody sentence or the placement determination makes the individual not eligible for GBMI group home services.

    Provider Authorization, Documentation, and Operational Rules

    Prior Authorization

    Provider must be an authorized GBMI provider

    Placement for GBMI group home services must be to an authorized GBMI provider: a Mental Health Center that holds a forensic group home endorsement or the Montana State Hospital (MSH). Ensure the selected provider holds the required endorsement/authorization before placement and billing.

    • Authorized providers: Mental Health Centers with forensic group home endorsement; Montana State Hospital (MSH).
    Step Therapy

    Step therapy: not specified

    No step therapy requirements are specified in this policy.

    Group Home (GBMI) Level of Care

    GBMI Group Home Treatment and Training

    GBMI group home treatment and training

    Treatment domains: Evaluation/assessment/navigation assistance; development of social networks; daily living skills facilitation and integration; identification and access to employment, education, and vocational training; plus ongoing community adjustment, personal care, socialization, and recreation/leisure

    [[chunk 3]]

    Treatment Time and Visit Requirements

    Treatment time required for GBMI reimbursement — Minimum 2 hours per day
    Minimum treatment timeGroup homes must provide a minimum of 2 hours of treatment per day to qualify for GBMI reimbursement
    Frequency requirementTreatment must be provided seven days per week
    Required treatment domainsEvaluation/assessment/navigation assistance; social network development; daily living skills facilitation; employment/education/vocational access
    Ongoing trainingCommunity adjustment, personal care, socialization, and recreation/leisure must be offered by all group home providers

    Key Terms and Authorized Providers

    GBMI — definition of 'Guilty But Mentally Ill' disposition
    GBMI definitionGUILTY BUT MENTALLY ILL (GBMI): A judicial disposition where an individual convicted of a crime is determined to have been mentally ill or developmentally disabled at the time of the offense and is sentenced to the custody of the DPHHS Director for placement in an appropriate facility
    Purpose of dispositionEnables placement in correctional, mental health, or developmental disability facilities for treatment and habilitation
    Applicable populationMembers involved in the criminal justice system who are sentenced to the custody of the DPHHS Director
    Authorized GBMI providers — Mental Health Centers with forensic group home endorsement and Montana State Hospital
    Authorized provider typesMental Health Centers with a forensic group home endorsement
    State facility

    Policy Background

    GUILTY BUT MENTALLY ILL (GBMI) is a judicial disposition used when an individual convicted of a crime is found to have been suffering from a mental disorder or developmental disability at the time of the offense. Under this disposition, a judge may sentence the person to the custody of the Director of DPHHS for placement in an appropriate correctional, mental health, or developmental disability facility. GBMI group homes are a community-based placement option when the individual has been specifically determined appropriate for release to a GBMI group home setting. The policy applies only to those individuals who meet both the judicial custody requirement and the placement appropriateness determination.

    Policy Summary
    PayerMontana Department of Public Health & Human Services
    PolicyGBMI Group Home Services Coverage Criteria
    Policy CodePolicy N/A
    Change TypeMinor review — no material changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionEnsure placement is to an authorized GBMI provider (Mental Health Center with forensic group home endorsement or the Montana State Hospital) and document judicial sentence and appropriateness for GBMI placement.
    SourceLink
    On This Page
    GBMI Group Home Coverage CriteriaProvider Authorization, Documentation, and Operational RulesGroup Home (GBMI) Level of CareGBMI Group Home Treatment and TrainingTreatment Time and Visit RequirementsKey Terms and Authorized ProvidersPolicy Background
    Documentation Required

    Suggested documentation to support placement and billing

    Document the court judicial sentence to the custody of the DPHHS Director, the clinical/legal determination that the individual is appropriate for release to a GBMI group home setting, provider credentialing/forensic endorsement (or MSH status), and records demonstrating delivery of required services and treatment time.

    • Judicial sentence to DPHHS custody authorizing placement in a GBMI setting.
    • Documentation that the individual was determined appropriate for GBMI group home placement.
    • Evidence of provider authorization (forensic group home endorsement) or MSH identity.
    • Clinical/service records showing delivery of minimum required services and treatment time (see service minimums).
    Denial Risk

    Eligibility trigger: judicial sentence and placement determination required

    Eligibility for GBMI group home placement requires a judicial sentence to the custody of the DPHHS Director and a determination that the individual is appropriate for release to a GBMI group home setting.

    Billing Rule

    Service minimums required for reimbursement

    To qualify for GBMI reimbursement, group homes must provide a minimum of two hours of treatment per day, seven days per week; failure to meet this minimum can result in denial of GBMI reimbursement.

    • Minimum treatment: at least 2 hours per day.
    • Minimum frequency: 7 days per week.
    • Required treatment domains include evaluation/assessment, social network development, daily living skills, employment/education/vocational access, plus ongoing community adjustment, personal care, socialization, and recreation/leisure.
    Montana State Hospital (MSH)
    Authorization notePlacement must be to an approved GBMI provider (endorsed Mental Health Center or MSH) to receive GBMI reimbursement