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BRULE Explanation (Sample)
SAMPLE BRULES
FOR MONTGOMERY COUNTY UNDER HIPAA
ADMCDDAYS

Type: 20

Short Desc: AOD MCD DAY SVC LMT

5000:5005;5060:5065

Limits AOD Medicaid Day Services (Ambulatory Detoxification and IOP) to One per Day

5000 Ambulatory Detox/HA/BLANK OR 99
5001 Ambulatory Detox/HA/H9
5002 Ambulatory Detox/HA/HD
5003 Ambulatory Detox/HF/BLANK OR 99
5004 Ambulatory Detox/HF/H9
5005 Ambulatory Detox/HF/HD
5060 Intensive Outpatient/HA/BLANK OR 99
5061 Intensive Outpatient/HA/H9
5062 Intensive Outpatient/HA/HD
5063 Intensive Outpatient/HF/BLANK OR 99
5064 Intensive Outpatient/HF/H9
5065 Intensive Outpatient/HF/HD

ADMCDOUTP

Type: 20

Short Desc: AOD MCD OUTPAT 15MIN

5040:5045;5050:5052

Limits AOD Medicaid 15 Minute Outpatient services to 96 Total Units (24 hours) per Day

5040 Group Counseling/HA/BLANK OR 99
5041 Group Counseling/HA/H9
5042 Group Counseling/HA/HD
5043 Group Counseling/HF/BLANK OR 99
5044 Group Counseling/HF/H9
5045 Group Counseling/HF/HD
5050 Individual Counseling/HF/BLANK OR 99
5051 Individual Counseling/HF/H9
5052 Individual Counseling/HF/HD

ADMCDOUTP2

Type: 20

Short Desc: AOD MCD OUTPAT 24HRS

5010:5015;5020:5025;
5030:5035;5080:5085

Limits AOD Medicaid Hourly Outpatient to 24 Total Units per Day

5010 Assessment/HA/BLANK OR 99
5011 Assessment/HA/H9
5012 Assessment/HA/HD
5013 Assessment/HF/BLANK OR 99
5014 Assessment/HF/H9
5015 Assessment/HF/HD
5020 Case Management/HA/BLANK OR 99
5021 Case Management/HA/H9
5022 Case Management/HA/HD
5023 Case Management/HF/BLANK OR 99
5024 Case Management/HF/H9
5025 Case Management/HF/HD
5030 Crisis Intervention/HA/BLANK OR 99
5031 Crisis Intervention/HA/H9
5032 Crisis Intervention/HA/HD
5033 Crisis Intervention/HF/BLANK OR 99
5034 Crisis Intervention/H9
5035 Crisis Intervention/HF/HD
5080 Medical/Somatic/HA/BLANK OR 99
5081 Medical/Somatic/HA/H9
5082 Medical/Somatic/HA/HD
5083 Medical/Somatic/HF/BLANK OR 99
5084 Medical/Somatic/HF/H9
5085 Medical/Somatic/HF/HD

OHINVALID

Type: 60

Short Desc: DENY INVALID MEDEF

A:ZZZZ

Deny Invalid Medef

MAGE MH Modifier Invalid for Adults
MINV Modifier Invalid for Procedure Code
ZRWJ RWJ - Invalid Plan Code (Cuya.-only)
ZNON Non-MCD Rejects - Fall Through
MTEL Telephone Modifier not valid
NODX Missing/Invalid Diagnosis
NPUA No Partial Units Allowed
ZMCD Medicaid Rejects - Fall Through
DXNA Diagnosis Not allowed

MHPARHOSPA

Type: 20

Short Desc: MH PAR HOSP ADULTS

1800;2800

MH Required Rule for All Plans:Limit 1 Session/Day Adults

1800 MCD Par Hospital-Adults/HE/BLANK OR 99/POS not 51/99

2800 Non-MCD Par Hospital-Adults/HE/BLANK OR 99/POS not 51/99

MHPARHOSPC

Type: 20

Short Desc: MH PAR H < 18

1805;2805

MH Required Rule for All Plans:Limit 2 Sessions/Day Children

1805 MCD Par Hospital-Children/HE/BLANK OR 99/POS not 51/99

2805 Non-MCD Par Hospital-Children/HE/BLANK OR 99/POS not 51/99

57B2002

Type: 60

Short Desc: NEW MEDEF EXCLUSION

2335;2345

Exclude New M/S Medefs for Client in Jail/SH CLI not Present

2335 Pharmacologic Mgmt/HE/UK/POS=99

2345 Pharmacologic Mgmt (Kids only)/HE/UK/POS=51

57FY200106

Type: 50

Short Desc: STD NONMCD EXCLUS-2

2340;2430:2445;2530;2680;2685

STD Non Medicaid Exclusions Part Two

2340 Pharmacologic Mgmt/HE/BLANK OR 99/POS=51
2430 BH Couns/Therapy-Ind/HE/BLANK OR 99/POS=99
2435 BH Couns/Therapy-Ind/HE/UK/POS=99 (Kids Only)
2440 BH Couns/Therapy-Ind/HE/BLANK OR 99/POS=51
2445 BH Couns/Therapy-Ind/HE/UK/POS=51 (Kids Only)
2530 BH Couns/Therapy-Group/HQ/BLANK OR 99/POS=99
2680 Com Psych Sup Therapy-Ind/GT/BLANK OR 99/POS=51
2685 Com Psych Sup Therapy-Ind/GT/UK/POS=51

5700000001

Type: 60

Short Desc: MH ONLY PLAN

4500;5000;6000;7000;7500

MH Only, Exclusions are AOD TX Services

4500 Acute Hospital Detox/HA/BLANK OR 99
5000 MCD Ambulatory Detox/HA/BLANK OR 99
6000 Non-MCD Ambulatory Detox/HA/BLANK OR 99
7000 Sub Acute Detox/HA/BLANK OR 99
7500 Alc/Other Sub Abuse not Otherwise Classified /HA/BLANK OR 99

5700000005

Type: 60

Short Desc: STD NONMCD EXCLUS-1

2035;2070;2075;2430;
2435;2530;2535;2730;2735

STD Non Medicaid Exclusions Part One

2035 Crisis Int MH Svcs/HE/UK/POS=99
2070 Crisis Int MH Svcs/GT/BLANK OR 99/POS=99
2075 Crisis Int MH Svcs/GT/UK/POS=99
2430 BH Couns/Therapy-Ind/HE/BLANK OR 99/POS=99
2435 BH Couns/Therapy-Ind/HE/UK/POS=99 (Kids Only)
2530 BH Couns/Therapy-Group/HQ/BLANK OR 99/POS=99
2535 BH Couns/Therapy-Group/HQ/UK/POS=99 (Kids Only)
2730 Com Psych Sup Therapy-Group/HQ/BLANK OR 99/POS=99
2735 Com Psych Sup Therapy-Group /HQ/UK/POS=99

5700000007

Type: 60

Short Desc: STD NONMCD EXCLUS-3

2040;2045;2080;2085;
2245;2340;2345;2440;2445

STD Non Medicaid Exclusions Part Three

2040 Crisis Int MH Svcs/HE/BLANK OR 99/POS=51
2045 Crisis Int MH Svcs/HE/UK/POS=51
2080 Crisis Int MH Svcs/GT/BLANK OR 99/POS=51
2085 Crisis Int MH Svcs/GT/UK/POS=51
2245 Psych Diag Int Exam-Phys/HE/UK/51 (Kids Only)
2340 Pharmacologic Mgmt/HE/BLANK OR 99/POS=51
2345 Pharmacologic Mgmt/HE/UK/POS=51 (Kids Only)
2440 BH Couns/Therapy-Ind/HE/BLANK OR 99/POS=51
2445 BH Couns/Therapy-Ind/HE/UK/POS=51 (Kids only)

5700000008

Type: 60

Short Desc: STD NONMCD EXCLUS-4

2540;2545;2680;2685;2740;2745

STD Non Medicaid Exclusions Part Four

2540 BH Couns/Therapy-Group/HQ/BLANK OR 99/POS=51
2545 BH Couns/Therapy-Group/HQ/UK/POS=51 (Kids only)
2680 Com Psych Sup Therapy-Ind/GT/BLANK OR 99/POS=51
2685 Com Psych Sup Therapy-Ind/GT/UK/POS=51
2740 Com Psych Sup Therapy-Group/HQ/BLANK OR 99/POS=51
2745 Com Psych Sup Therapy-Group/HQ/UK/POS=51

5700000012

Type: 60

Short Desc: PREV/ADJUNC ONLY

!3620:3780;!7500:7625;!7660:7663

PREV/ADJU Only MH and AOD

3620 BH Hotline/HE/BLANK OR 99
3640 Consumer Operated/HE/BLANK OR 99
3660 Self Help/Peer Support/HE/BLANK OR 99
3680 MH Svcs not Otherwise Specified/HE/BLANK OR 99
3680 Other MH Svc (Non Healthcare)/HE/BLANK OR 99
3720 Prevention/HE/BLANK OR 99
3740 Consultation/HE/BLANK OR 99
3760 Info and Referral/HE/BLANK OR 99
3780 Comm Education/HE/BLANK OR 99
7500 Alc/Other Sub Abuse not Otherwise Classified/HA/BLANK OR 99
7501 Alc/Other Sub Abuse not Otherwise Classified/HA/H9
7502 Alc/Other Sub Abuse not Otherwise Classified/HA/HD
7503 Alc/Other Sub Abuse not Otherwise Classified/HF/BLANK OR 99
7504 Alc/Other Sub Abuse not Otherwise Classified/HA/H9
7505 Alc/Other Sub Abuse not Otherwise Classified/HF/HD
7510 Alternatives/HA/BLANK OR 99
7511 Alternatives/HA/H9
7512 Alternatives/HA/HD
7513 Alternatives/HF/BLANK OR 99
7514 Alternatives/HF/HA
7515 Alternatives/HF/HD
7530 Comm Based Process/HA/BLANK OR 99
7531 Comm Based Process/HA/H9
7532 Comm Based Process/HA/HD
7533 Comm Based Process/HF/BLANK OR 99
7534 Comm Based Process/HF/HA
7535 Comm Based Process/HF/HD
7540 Consultation/HA/BLANK OR 99
7541 Consultation/HA/H9
7542 Consultation/HA/HD
7543 Consultation/HF/BLANK OR 99
7544 Consultation/HF/H9
7545 Consultation/HF/HD
7550 Education (Prevention)/HA/BLANK OR 99
7551 Education (Prevention)/HA/H9
7552 Education (Prevention)/HA/HD
7553 Education (Prevention)/HF/BLANK OR 99
7554 Education (Prevention)/HF/HA
7555 Education (Prevention)/HF/HD
7560 Environmental/HA/BLANK OR 99
7561 Environmental/HA/H9
7562 Environmental/HA/HD
7563 Environmental/HF/BLANK OR 99
7564 Environmental/HF/HA
7565 Environmental/HA/BLANK OR 99
7570 Information Dissemination/HA/BLANK OR 99
7571 Information Dissemination/HA/H9
7572 Information Dissemination/HA/HD
7573 Information Dissemination/HF/BLANK OR 99
7574 Information Dissemination/HF/HA
7575 Information Dissemination/HF/HD
7580 Intervention/HA/BLANK OR 99
7581 Intervention/HA/H9
7582 Intervention/HA/HD
7583 Intervention/HF/BLANK OR 99
7584 Intervention/HF/H9
7585 Intervention/HF/HD
7600 Problem ID and Referral/HA/BLANK OR 99
7601 Problem ID and Referral/HA/H9
7602 Problem ID and Referral/HA/HD
7603 Problem ID and Referral/HF/BLANK OR 99
7604 Problem ID and Referral/HF/HA
7605 Problem ID and Referral/HF/HD
7610 Referral and Information/HA/BLANK OR 99
7611 Referral and Information/HA/H9
7612 Referral and Information/HA/HD
7613 Referral and Information/HF/BLANK OR 99
7614 Referral and Information/HF/H9
7615 Referral and Information/HF/HD
7620 Training/HA/BLANK OR 99
7621 Training/HA/H9
7622 Training/HA/HD
7623 Training/HF/BLANK OR 99
7624 Training/HF/H9
7625 Training/HF/HD
7660 Transportation/HA/BLANK OR 99
7661 Transportation/HA/HD
7662 Transportation/HF/BLANK OR 99
7663 Transportation/HF/HD

5700000013

Type: 50

Short Desc: OOC HOLDS #1

2000;3580;4000:4999;6000:8000

Out of County Holds Part One

2000 Crisis Int MH Svcs/HE/BLANK OR 99/POS not 51/99
3580 Temporary Housing/HE/BLANK OR 99
4500 Acute Hospital Detox/HA/BLANK OR 99
4501 Acute Hospital Detox/HA/H9
4502 Acute Hospital Detox/HF/BLANK OR 99
4503 Acute Hospital Detox/HF/H9
4510 BH Med Comm Res TX Hospital/HA/BLANK OR 99
4511 BH Med Comm Res TX Hospital/HA/H9
4512 BH Med Comm Res TX Hospital/HF/BLANK OR 99
4513 BH Med Comm Res TX Hospital/HF/H9
4520 Med Comm Res-Hospital Setting/HA/BLANK OR 99
4521 Med Comm Res-Hospital Setting/HA/H9
4522 Med Comm Res-Hospital Setting/HF/BLANK OR 99
4523 Med Comm Res-Hospital Setting/HF/H9

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SUBSIDY RIDER EXPLANATIONS
FOR MONTGOMERY COUNTY UNDER HIPAA

All RIDERS APPLY TO ALL SERVICES OTHER THAN RESIDENTIAL SERVICES

BRULE
TYPE
MEDEFS
DESC.
Rider Code
%Board Pays
%Client Pays
570SSUBSID
10
2000:3350;6000:6115
00% BOARD SUBSIDY
T
0
100
57100SSUBS
10
2000:3350;6000:6115
100% BOARD SUBSIDY
Z
100
0
5705SUBSID
10
2000:3350;6000:6115
05% SUBSIDY
S
5
95
5710SUBSID
10
2000:3350;6000:6115
10% SUBSIDY
R
10
90
5715SUBSID
10
2000:3350;6000:6115
15% SUBSIDY
Q
15
85
5720SUBSID
10
2000:3350;6000:6115
20% SUBSIDY
P
20
80
5725SUBSID
10
2000:3350;6000:6115
25% SUBSIDY
O
25
75
5730SUBSID
10
2000:3350;6000:6115
30% BOARD SUBSIDY
N
30
70
5735SUBSID
10
2000:3350;6000:6115
35% BOARD SUBSIDY
M
35
65
5740SUBSID
10
2000:3350;6000:6115
40% BOARD SUBSIDY
L
40
60
5745SUBSID
10
2000:3350;6000:6115
45% BOARD SUBSIDY
K
45
55
5750SUBSID
10
2000:3350;6000:6115
50% BOARD SUBSIDY
J
50
50
5755SUBSID
10
2000:3350;6000:6115
55% BOARD SUBSIDY
I
55
45
5760SUBSID
10
2000:3350;6000:6115
60% BOARD SUBSIDY
H
60
40
5765SUBSID
10
2000:3350;6000:6115
65% BOARD SUBSIDY
G
65
35
5770SUBSID
10
2000:3350;6000:6115
70% BOARD SUBSIDY
F
70
30
5775SUBSID
10
2000:3350;6000:6115
75% BOARD SUBSIDY
E
75
25
5780SUBSID
10
2000:3350;6000:6115
80% BOARD SUBSIDY
D
80
20
5785SUBSID
10
2000:3350;6000:6115
85% BOARD SUBSIDY
C
85
15
5790SUBSID
10
2000:3350;6000:6115
90% BOARD SUBSIDY
B
90
10
5795SUBSID
10
2000:3350;6000:6115
95% BOARD SUBSIDY
A
95
5