CurrentMontana Department of Public Health & Human ServicesPolicy 452

Mobile Crisis Response Services

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Defines Montana Medicaid coverage, provider and service requirements, and medical necessity criteria for mobile, community-based behavioral health crisis response and stabilization services for members experiencing mental health or substance use crises.

Policy Summary

PayerMontana Department of Public Health & Human Services

PolicyMobile Crisis Response Services

Policy CodePolicy 452

Change TypeNo material change

Effective DateJul 1, 2023

Next Review Date

Key ActionProvide in-person, community-based mobile crisis response and document a biopsychosocial assessment, stabilization, referrals, and follow-up care coordination; enroll as an approved Montana Medicaid crisis provider.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

24/7 option24/7 option

1–2 hourTarget response

In-person onlyReimbursement

No prior authPrior auth

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CurrentMontana Department of Public Health & Human ServicesPolicy 452

Mobile Crisis Response Services

Customize your policy alerts

Sign up for Montana Department of Public Health & Human Services Policy 452 alerts

Get alerted when Policy 452 changes without checking for updates manually.

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Policy Summary

PayerMontana Department of Public Health & Human Services

PolicyMobile Crisis Response Services

Policy CodePolicy 452

Change TypeNo material change

Effective DateJul 1, 2023

Next Review Date

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

24/7 option24/7 option

1–2 hourTarget response

In-person onlyReimbursement

No prior authPrior auth

Coverage and Medical Necessity

Medical Necessity Criteria

Covered when ALL of the following are met

Medical necessity for Mobile Crisis Response Services: (1) The member is experiencing a behavioral health crisis that is unable to be resolved by phone triage, or phone triage was not available; (2) Rapid intervention is needed to attempt to stabilize the member's condition safely; (3) The member requires at least one of the following to diffuse the crisis: (a) psychotherapy; (b) mobilization of resources to defuse the crisis and restore safety; or (c) provision of psychotherapeutic intervention to minimize emotional trauma; (4) The member may require the following to prevent further crisis: (a) referrals to outpatient care and other appropriate care; or (b) follow up care coordination to connect with ongoing services.

Exact numbered items and subitems preserved; logical AND across numbered items.

Services are limited to community-based settings and are not covered when delivered inside a hospital, jail, or other facility. Responses must be dispatched and provided in the community and be capable of responding without law enforcement present. The policy requires that services be available every day of the year and be capable of meeting target dispatch-to-arrival times of within 1 hour for urban areas and within 2 hours for rural/frontier areas, when weather and travel distance allow.

Mobile Crisis Response must be delivered in-person. When a multidisciplinary mobile crisis team responds, at least one team member must be physically present; a single team member may participate via telehealth but must remain connected for the duration of the response. Reimbursement is limited to the in-person response time only.

Provider Requirements, Billing, and Operational Notes

Prior Authorization

No prior authorization required

Prior authorization is not required for Mobile Crisis Response Services.

Step Therapy

Phone triage must have failed or been unavailable

Member must be experiencing a behavioral health crisis that is unable to be resolved by phone triage, or phone triage was not available; phone triage resolution is a required antecedent before deploying mobile crisis response.

Medical necessity criterion: “The member must be experiencing a behavioral health crisis that is unable to be resolved by phone triage, or phone triage was not available.”

Level of Care — Community Mobile Crisis

Permitted Treatment Modalities

In-person crisis intervention (may include one team member via telehealth if team response)

Allowed interventions during in-person crisis response (team may include one member via telehealth if team response)

Allowed interventions during response: Screening and assessment, as clinically appropriate; stabilization and de-escalation; arrangement of mobile crisis care coordination services with referrals to health, social, and other services and supports; and facilitation of a warm handoff to ongoing care when reimbursing in-person response time.

Services must be delivered in-person; when provided by a team, at least one team member must respond in-person — one team member may respond via telehealth and remain connected for the duration of the response.

Visit Limits and Reimbursement

inv-12: Mobile Crisis Response — Reimbursement limited to in-person response time

Reimbursement ruleServices can only be reimbursed for the in‑person response time; claims for non‑in‑person response time may be denied.

In‑person requirement for teamsWhen furnished by a mobile crisis team, the responding team must have at least one team member responding in‑person; one team member may respond via telehealth but must remain connected throughout the response.

Includes warm handoffReimbursable in‑person response time may include facilitation of a warm handoff for ongoing care.

Dispatch‑to‑arrival targetsServices must be able to respond within one hour in urban areas and within two hours in rural/frontier areas when weather and travel distance allow.

Definitions and Staffing Models

inv-08: Mobile Crisis Response Services definition — integrated, short-term crisis response delivered in the community

DefinitionMobile Crisis Response Services provide integrated, short‑term crisis response, stabilization, and intervention delivered in the community to identify, assess, treat, and stabilize behavioral health or substance use crises and reduce immediate danger.

Purpose and scopeMobile, on‑site therapeutic response to identify, assess, treat, and stabilize situations and reduce immediate risk to the member or others; includes arranging referrals and follow‑up to connect to ongoing services.

Community deliveryServices must be provided in the community, outside of a hospital, jail, or other facility setting.

Service elementsServices must include screening and assessment, stabilization and de‑escalation, and arrangement of Mobile Crisis Care Coordination Services with referrals to health, social, and other supports.

inv-09: Staffing model options — individual responder and multidisciplinary team options

Background

Mobile Crisis Response Services provide short-term, on-site crisis interventions to identify, assess, treat, stabilize, and reduce immediate risk for members experiencing behavioral health or substance use crises in the community. Services must include screening and assessment as clinically appropriate, stabilization and de-escalation, and arranging care coordination and referrals to health, social, and other supports.

The purpose of these services is rapid, community-based stabilization and linkage to ongoing care. To support that purpose, services must be dispatchable without reliance on law enforcement, available every day of the year, and delivered in-person so that responders can perform on-scene assessment, de-escalation, and facilitate warm handoffs or referrals to follow-up care.