Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the adoption of New Rules I through XXVII pertaining to behavioral health inpatient facilities (BHIF)

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION

TO: All Concerned Persons

1. On June 19, 2009, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed adoption of the above-stated rules.

2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on June 10, 2009, to advise us of the nature of the accommodation that you need. Please contact Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail [email protected].

3. The rules as proposed to be adopted provide as follows:

RULE I SCOPE (1) A behavioral health inpatient facility (BHIF) is intended to provide secured inpatient psychiatric treatment for up to 16 persons, 18 years of age or older, involuntarily committed or detained, or to persons seeking treatment voluntarily. A BHIF is not subject to hospital EMTALA regulations. While a BHIF is defined at 53-21-102, MCA, as a mental health facility, a BHIF shall be subject to all health care facility/service standards found at Title 50, chapter 5, parts 1 and 2, MCA, in order to be licensed.

AUTH: 50-5-103, 53-21-194, MCA

IMP: 50-5-103, 53-21-101, 53-21-194, MCA

RULE II PURPOSE (1) The purpose of these rules is to establish minimum state health care facility/service licensing standards for secured nonhospital based, acute inpatient psychiatric treatment for persons, who may also have co-occurring substance use disorders; who are involuntarily committed or detained; or to persons seeking behavioral health treatment voluntarily. While a BHIF is not a hospital, it may be collocated with a hospital.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE III APPLICATION OF OTHER RULES (1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter shall apply to a behavioral health inpatient facility.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE IV DEFINITIONS For the purposes of this subchapter, the following definitions apply:

(1) "Administrator" means the person designated on the facility application or by written notice to the department as the person responsible for the daily operation of the facility and for the daily inpatient treatment provided in the facility.

(2) "Assessment" means an active process that utilizes a multidisciplinary team throughout the care and treatment of an individual.

(3) "BHIF" means behavioral health inpatient facility as defined at 53-21-102, MCA.

(4) "Clinical record" means a written document which is complete, current, and contains the information required by 53-21-165, MCA.

(5) "Emergency situation" has the meaning assigned to it by 53-21-102, MCA.

(6) "Governing body" means a group of designated persons functioning as a governing body, that is legally responsible for establishing and implementing policies regarding the management and operations of the facility.

(7) "Licensed health care professional" means a licensed health care professional as defined at 50-5-101, MCA.

(8) "Medical director" means a physician, psychiatrist, or advanced practice registered nurse who oversees the medical care and other designated care and services in a behavioral health inpatient facility. The medical director is responsible for coordinating medical care and helping to develop, implement, and evaluate patient care policies and procedures that reflect current standards of practice.

(9) "Mental health professional" means a mental health professional as defined at 53-21-102, MCA.

(10) "Professional person" means a professional person as defined at 53-21-102, MCA.

(11) "Supervisor" means a site based certified mental health professional person.

(12) "Treatment plan" means a planned program of active treatment developed by a multidisciplinary team to meet an individual's recovery and care.

AUTH: 53-21-194, MCA

IMP: 50-5-101, 53-21-102, 53-21-194, MCA

RULE V LICENSE APPLICATION PROCESS (1) Application for a health care facility/service license accompanied by the required fee shall be made to the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953 upon forms provided by the department and shall include full and complete information as to:

(a) the name and address of the applicant if an individual, the name and address of each member if a firm, partnership, or association; or the name and address of each officer if a corporation;

(b) the location of the facility;

(d) the number and type of patients or residents for which care is provided;

(e) any information which the department may require pertaining to the number, experience, and training of employees; and

(f) information on ownership, contract, or lease agreement if operated by a person other than the owner.

(2) The fee for licensure is $20.00.

(3) Every facility shall have a distinct identification or name and shall notify the department in writing within 30 days prior to changing such identification or name, changing ownership, or relocating the facility.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE VI GOVERNING BODY (1) The licensee must establish a governing body with responsibility for operating and maintaining the BHIF. The governing body must include the facility's medical director and the facility administrator. The governing body provides organizational guidance and oversight to ensure the provision of safe, effective patient treatment and care to include but not limited to:

(a) adopting, reviewing, and updating as necessary, at least on an annual basis, policies that:

(i) govern the organization and functions of the BHIF;

(ii) provide a process for grievance and conflict resolution for both staff and patients; and

(iii) provide clear lines of authority for administering, managing, and operating the facility.

(b) establishing procedures for recruiting, hiring, and at least annually evaluating the qualified administrator to assure implementation of the facility goals, objectives, and policies and procedures as approved by the governing body;

(c) review all written facility policies and procedures, to ensure they implement all rules and regulations; are current; known to all staff, and available to all staff, patients, law enforcement, or the public; and

(d) approving facility human resource procedures to assure the facility establishes safe hiring and continued employment practices.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE VII MEDICAL DIRECTOR (1) Each facility shall employ or contract with a medical director who shall:

(a) coordinate with and advise the staff of the facility on clinical matters;

(b) provide direction, consultation, and training regarding the facility programs and operations as needed;

(c) act as a liaison for the facility with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services; and

(d) ensure the quality of treatment and related services through participation in the facility quality assurance process.

(2) The facility physician, psychiatrist, or advanced practice registered nurse may also serve as the facility medical director.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE VIII ADMINISTRATOR RESPONSIBILITIES (1) Each facility shall employ an administrator who shall:

(a) be responsible for operation of the facility at all times and shall ensure 24-hour supervision of the patients;

(b) maintain daily overall responsibility for the facility operations;

(c) develop and oversee the implementation of all policies and procedures pertaining to the operation and services of the facility;

(d) establish written policies and procedures for all facility human resource services;

(e) establish a process for patient complaints and grievances, to include an opportunity for appeal, and to inform patients of the availability of advocacy organizations to assist them;

(f) establish a patient incident report file on all patient incidents or allegation of abuse;

(g) develop and maintain an organizational chart that delineates the current lines of authority, responsibility, and accountability for the administration and provision of all facility patient treatment programs services; and

(h) develop and implement written orientation and training procedures on all facility policies and procedures for all employees or contractors, relief workers, temporary employees, students, interns, volunteers, and trainees to include but not limited to:

(i) defining the responsibilities, limitations, and supervision of students, interns, and volunteers working for the BHIF; and

(ii) verifying each professional staff member's credentials, when hired, and annually thereafter, to ensure the continued credentialing of required licenses.

(2) The administrator shall develop policies and procedures for screening, hiring, and assessing staff which include practices that assist the employer in identifying employees that may pose risk or threat to the health, safety, or welfare of any resident and provide written documentation of findings and the outcome in the employee's file.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE IX ADMINISTRATOR ABSENCE (1) In the absence of the administrator, a staff member must be designated to oversee the operation of the facility during the administrator's absence. The administrator or designee shall be in charge, on call and physically available on a daily basis as needed, and shall ensure there are sufficient, qualified staff so that the care, active treatment, health, welfare, and safety needs of the residents are met at all times.

(2) If the administrator will be absent from the facility for more than 30 consecutive calendar days, the department shall be given written notice of the individual who has been appointed the designee.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE X WRITTEN POLICIES AND PROCEDURES (1) Each BHIF shall maintain a policy and procedure manual. The policy and procedure manual shall be reviewed and updated as necessary, but at least annually.

(2) The manual shall contain but not be limited to policies and procedures for:

(a) notifying staff of all changes in policies and procedures;

(b) addressing patient rights, including a procedure for informing patients of their rights;

(d) addressing and reviewing ethical issues faced by staff and reporting allegations of ethics violations to the applicable professional licensing authority;

(e) admitting criteria and process to initiate behavioral treatment services to patients;

(f) developing procedures for the transfer of a patient to another hospital or facility;

(g) establishing fiscal policies governing the management of organizational and individual funds;

(h) developing and implementing policy(s) for security;

(i) establishing and maintaining a facility staffing procedure;

(j) assessment criteria for new admissions;

(k) informing patients of policies pertaining to secured treatment, suspension of treatment, transfer to other facilities, or discontinuation of services for voluntary patients;

(l) suspending or discontinuing facility services with the following information to be provided to the patient:

(i) the reason for suspending or discontinuing services or access to programs;

(ii) the conditions that must be met to resume services or access to programs;

(iii) the grievance procedure that may be used to appeal the suspension or discontinuation; and

(iv) what services, if any, will be continued to be provided even though participation in a particular service or program may be suspended or discontinued.

(m) referring patients to other providers or services that the facility does not provide; and

(n) conducting quality assessment and improvement activities.

(3) The policy and procedure manual must include a current organizational chart delineating the current lines of authority, responsibility, and accountability for the administration and provision of all facility patient treatment programs and services.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XI DIRECT CARE AND OTHER EMPLOYEES (1) Employees shall receive orientation and training in areas relevant to the employee's duties and responsibilities including:

(a) an overview of the facility's policies and procedure manual in areas relevant to the employee's job responsibilities;

(b) a review of the employee's job description;

(d) rights of persons served; and

(e) safety and emergency response procedures.

(2) In addition to meeting the requirements of (4), direct care staff shall be trained to perform the services established in each patient treatment plan.

(3) All direct care staff must receive full orientation before providing direct patient care or treatment.

(4) The following must be met in staffing the facility:

(a) direct care staff shall have knowledge of the patient's needs and any events about which the employee should notify the administrator or the administrator's designated representative;

(b) the facility shall have a sufficient number of qualified staff on duty 24 hours a day to meet the scheduled and unscheduled needs of each patient, to respond in emergency situations, and to provide active treatment and provision of all related services including but not limited to:

(i) maintenance of order, safety, and cleanliness;

(ii) assistance with medication regimens;

(iii) preparation and service of meals;

(iv) housekeeping services and assistance with laundry; and

(v) assurance that each patient receives the supervision and care required by the treatment plan to meet the patient's basic needs.

(c) an individual on each work shift shall have keys to all relevant patient care areas and access to all items needed to provide appropriate patient treatment and care.

(5) The facility will employ registered nurses. The facility must be staffed by a registered nurse 24 hours a day, seven days per week. The RN may also serve as a supervisor.

AUTH: 53-21-194, MCA

IMP: 53-21-161, 53-21-194, MCA

RULE XII CLINICAL RECORDS (1) A patient clinical record shall be created upon the patient's admission to the BHIF. The clinical records must comply with the requirements of 53-21-165 and 53-21-166, MCA. Clinical records must be retained for five years following the date of discharge or death. However, facilities that participate in Medicaid or Medicare programs must keep the clinical records for the applicable minimum retention period.

AUTH: 53-21-194, MCA

IMP: 53-21-165, 53-21-166, 53-21-194, MCA

RULE XIII PERSONNEL RECORDS (1) The facility is responsible for establishing, maintaining, and securing a file on each employee, substitute personnel, intern, volunteer, and contractor.

(2) The following documentation from personnel files must be made available to the department at all reasonable times, but shall be made available to the department within 24 hours after the department requests to review the files.

(a) the employee's name;

(b) a copy of current credentials, certifications, or professional licenses as required to perform the job description;

(d) initialed documentation of employee orientation and ongoing training.

(3) The facility shall keep a personnel file that meets the requirements set forth in (2) for the administrator of the facility, even when the administrator is also the facility owner.

AUTH: 53-21-106, 53-21-194, MCA

IMP: 53-21-106, 53-21-194, MCA

RULE XIV PATIENT ASSESSMENTS (1) The facility shall utilize a multidisciplinary team which may include but is not limited to the patient, social workers, addiction counselors, licensed mental health professionals, licensed practical nurses, mental health technicians, peer support staff, registered nurses, psychologists, case managers, certified mental health professional persons, clergy, and family members.

(2) Each facility shall initiate a clinical intake assessment within 12 hours after admission for program services. Intake assessments must be conducted by a licensed mental health professional or licensed health care professional trained in clinical assessments and must include the following information in a narrative form to substantiate the patient's diagnosis and provide sufficient detail to individualize treatment plan goals and objectives:

(a) presenting problem and history of problem;

(b) mental status;

(d) initial treatment plan goals;

(e) risk factors to include suicidal or homicidal ideation;

(f) psychiatric history;

(g) substance use/abuse and history;

(h) current medication and medical history;

(i) financial resources;

(j) family relationships;

(k) housing history and housing arrangements;

(l) nutritional needs;

(m) cultural and spiritual needs;

(n) education and/or work history;

(o) legal history relevant to history of illness, including guardianships, civil commitments, criminal mental health commitments, current and prior criminal background, and current legal status; and

(p) anticipated discharge needs.

(3) Based on the patient's clinical needs, the facility shall conduct additional assessments which may include, but are not limited to, physical, psychological, emotional, behavioral, psychosocial, recreational, vocational, psychiatric, and chemical dependency evaluations.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XV INDIVIDUALIZED TREATMENT PLANNING (1) Based upon the findings of the assessment(s), the facility shall initiate an individualized treatment plan for each patient within 24 hours of admission. The treatment plan must conform to requirements outlined in 53-21-162, MCA, be completed within ten days of admission, and:

(a) identify treatment team members, from within and outside of the facility, who are involved in the patient's treatment or care;

(b) specifically state measurable treatment plan objectives that serve the patient in the least restrictive and most culturally appropriate therapeutic environment;

(c) describe the service or intervention with sufficient specificity to demonstrate the relationship between the service or intervention and the stated objective;

(d) identify the staff person and program responsible for each treatment service to be provided;

(e) include the patient's guardian or power of attorney's signature indicating participation in the development of the treatment plan. If the patient's or guardian's participation is not possible or inappropriate, written documentation must indicate the reason;

(f) include the signature and date of the facility's licensed mental health professional and of the person(s) with primary responsibility for implementation of the treatment plan indicating development and ongoing review of the plan; and

(g) state the criteria for discharge, including the patient's level of functioning which will indicate when a particular service is no longer required.

(2) The treatment plan must be reviewed at least every 30 days for each patient and whenever there is a significant change in the patient's condition. A change in level of care or referrals for additional services must be included in the treatment plan.

(3) The treatment plan review must be conducted by at least one licensed mental health professional from the facility and include persons with primary responsibility for implementation of the plan. Other staff members must be involved in the review process as clinically indicated.

(4) A treatment team meeting for establishing an individual treatment plan and for treatment plan review must be conducted face-to-face and include:

(a) the patient as clinically appropriate;

(b) the patient's guardian or the holder of the patient's power of attorney if applicable;

(d) peer support, or adult friend or family member may be invited to participate in the treatment planning or treatment plan review meeting, at the request of and upon written consent of the patient, and as deemed clinically appropriate by the patient's treatment team, prior to the scheduling of the meeting.

(5) The treatment plan review must be comprehensive with regard to the patient's response to treatment and result in either an amended treatment plan or a statement of the continued appropriateness of the existing plan. The results of the treatment plan review must be entered into the patient's clinical record. The documentation must include a description of the patient's functioning and justification for each patient goal.

(6) If the facility develops separate treatment plans for each service, the treatment plans must be integrated with one another and a copy of each treatment plan must be kept in the patient's record.

(7) Minimum components of treatment plans include:

(a) assessment, medication administration and management;

(b) discharge planning;

(d) patient education;

(e) individual, group, and family therapies; and

(f) physical activity.

(8) Patient need and the patient's treating psychiatrist or mental health professional determine the length of stay.

(a) The maximum length of stay for a patient who is involuntarily committed is limited to the period authorized by the court order of commitment. Extension of commitment to a BHIF pursuant to 53-21-128, MCA, is not permitted.

AUTH: 53-21-194, MCA

IMP: 53-21-128, 53-21-162, 53-21-194, MCA

RULE XVI RESTRAINT AND SECLUSION (1) The facility must be capable of providing restraint or seclusion and must ensure that the restraint or seclusion is performed in compliance with 53-21-146, MCA.

(2) Restraint and seclusion must be performed in a manner that is safe, proportionate and appropriate to the severity of the behavior, the patient's size, gender, physical, medical, and psychiatric condition, and personal history.

(3) Restraint or seclusion may be used in emergency situations when needed to ensure the physical safety of the individual patient or other patients or staff of the facility and when less restrictive measures have been found to be ineffective to protect the resident or others from harm.

(4) Restraint and seclusion procedures must be implemented in the least restrictive manner possible in accordance with a written modification to the patient's health care/treatment plan and discontinued when the behaviors that necessitated the restraint or seclusion are no longer in evidence.

(5) "Whenever needed" or "as needed" PRN standing orders for use of restraint or seclusion are prohibited.

(6) A physician or other authorized health care provider must authorize use of the restraint or seclusion within one hour of initiating the restraint or seclusion.

(7) Each order of restraint or seclusion is limited in length of time to four hours.

(8) A facility will have at a minimum one "comfort/safe" room per 16 beds for use for patient seclusion as prescribed by the facility's policy and procedures, and in accordance with applicable state and federal standards.

AUTH: 53-21-194, MCA

IMP: 53-21-146, 53-21-194, MCA

RULE XVII DISCHARGE (1) The patient must be provided with an aftercare plan upon discharge.

(2) Each facility shall prepare a discharge plan for each patient no longer receiving services. The discharge plan must include:

(a) the reason for discharge;

(b) a summary of the services provided by the facility including recommendations for aftercare services and referrals to other services, if applicable;

(c) an evaluation of the client's progress as measured by the treatment plan and the impact of the services provided by the facility;

(d) diagnosis and response to medications; and

(e) the signature of the staff member who prepared the report and the date of preparation.

(3) The discharge summary must be filed in the clinical record within 72 hours after patient is discharged from the BHIF.

AUTH: 53-21-194, MCA

IMP: 53-21-180, 53-21-194, MCA

RULE XVIII TRANSFER/DISCHARGE TO ANOTHER FACILITY (1) A patient may be discharged and transferred to another facility pursuant to 53-21-111, MCA, at any time. The facility will contact the receiving facility to determine if a bed is available and to provide information about the individual being transferred.

(2) A patient who has been involuntarily committed to a BHIF pursuant to 53-21-127, MCA, may be transferred to another facility if the court which committed the patient to the BHIF has issued an order to transfer or an order committing the patient to the other facility.

(3) A patient for whom a petition for extension of commitment has been filed pursuant to 53-21-128, MCA, may be transferred to another facility if the court in which the petition is filed has issued an order to transfer or an order committing the patient to the other facility.

(4) If an emergency situation exists, the patient may be involuntarily transferred for admission to Montana State Hospital without a court order in accordance with 53-21-129, MCA, until the next business day.

(5) The patient's medical information and commitment order must accompany the patient.

AUTH: 53-21-194, MCA

IMP: 53-21-111, 53-21-128, 53-21-129, 53-21-194, MCA

RULE XIX PATIENT RIGHTS (1) Patients admitted to a behavioral health inpatient facility shall be afforded all of the rights of a patient provided for in Title 53, chapter 21, part 1, MCA, Treatment of the Seriously Mentally Ill.

(2) A copy of these rights shall be posted in a conspicuous place within the facility.

(3) These rights will also be explained to the patient in terms that the patient can understand.

AUTH: 53-21-101, 53-21-194, MCA

IMP: 53-21-101, 53-21-168, 53-21-194, MCA

RULE XX SECURITY (1) The facility shall develop security policies which address the following:

(a) securing the treatment unit;

(b) development of an emergency, fire, disaster, evacuation, and response plan; and

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XXI PHYSICAL PLANT (1) The building shall be considered an I - 2 occupancy for purpose of issuing a building permit.

(2) The building shall be classified as a New Health Care Occupancy or Existing Health Care Occupancy as found in Chapter 18 or Chapter 19 of the 2001, NFPA 101 - Life Safety Code. Copies of the codes may be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471, phone 1-617-770-3000.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XXII COMMON USE AREAS (1) At least two separate social spaces, one appropriate for noisy activities and one for quiet activities, shall be provided. The combined area shall be at least 25 square feet for each of the two spaces. This space may be shared by dining activities if an additional 15 square feet per patient is added; otherwise, provide 20 square feet for patient dining. Dining facilities may be located off the nursing unit in a central area.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XXIII PATIENT TOILETS AND BATHING (1) There must be at least one toilet available for every four patients in the facility.

(2) There must be at least one bathing unit for every six patients in the facility. A shower or tub is not required if the facility utilizes a central bathing unit for every six patients.

(3) All doors to toilet rooms or bathing unit must swing out or slide into the wall and shall be able to be unlocked from the outside. Toilet rooms and bathing facilities may be under key control by staff.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XXIV INFECTION CONTROL (1) The facility must establish and maintain infection control policies and procedures sufficient to provide a safe environment and to prevent the transmission of disease. Such policies and procedures must, at a minimum, include the following:

(a) any employee contracting a communicable disease that is transmittable to residents through food handling or direct care must not appear at work until the infectious disease(s) can no longer be transmitted;

(b) diagnosis and treatment of communicable or infectious disease occurrence and that appropriate safety measures are taken on behalf of that patient, of other patients, staff, and visitors; and

(2) The facility shall comply with statutes and rules regarding the handling and disposal of biohazardous waste.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XXV FOOD SERVICE (1) Facilities shall comply with the regulations concerning food service establishments which are located at ARM Title 37, chapter 110, subchapter 2.

(2) Facilities shall provide for the patient's nutritional needs as prescribed by the patient's doctor.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XXVI LAUNDRY AND HOUSEKEEPING (1) Laundry and housekeeping services must be provided by the facility. A contracted service provider or the facility directly may provide laundry and housekeeping services.

(2) Facility administrators will ensure that provisions are made to accommodate patient laundry and housekeeping to assure a safe and clean environment.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

RULE XXVII QUALITY ASSESSMENT (1) Each facility shall implement and maintain an active quality assessment program using information collected to make improvements in the facility's policies, procedures, and services. At a minimum, the program must include procedures for:

(a) conducting patient satisfaction surveys, at least annually, for all facility programs. The survey must address:

(i) whether the patient, parent, or guardian is adequately involved in the development and review of the patient's treatment plan;

(ii) whether the patient, parent, or guardian was informed of patient's rights and the facility's grievance procedure;

(iii) the patient's, parent's, or guardian's satisfaction with all facility programs in which the patient participated; and

(iv) the patient's, parent's, or guardian's recommendations for improving facility's services.

(b) maintaining records on the occurrence, duration, and frequency of seclusion and physical restraints used; and

(c) reviewing, on an ongoing basis, incident reports, grievances, complaints, medication errors, and the use of seclusion and/or physical restraint with special attention given to identifying patterns and making necessary changes in how services are provided.

(2) Each facility shall prepare and maintain on file an annual report of improvements made resulting from the quality assessment program.

AUTH: 53-21-194, MCA

IMP: 53-21-194, MCA

4. The department is proposing the adoption of new Rules I through XXVII to promulgate the minimum licensing standards for behavioral health inpatient facilities (BHIF). Section 53-21-194, MCA enables the department to license behavioral health inpatient facilities to provide inpatient psychiatric care to persons involuntarily committed or detained under Title 53, MCA or to persons seeking treatment voluntarily. Section 53-21-194, MCA also requires the department to adopt rules governing the qualifications for licensure of BHIFs. These proposed licensure rules provide the minimum licensing standards for BHIFs specifically while coordinating with the provisions of Title 50, chapter 5, parts 1 and 2, MCA, and applicable rules from ARM Title 37, chapter 106 regarding hospitals and related health facilities.

In addition to being required by statute, the rules are necessary to inform potential providers and recipients of behavioral health inpatient facility services of the expectations necessary in order to be licensed and address for patients various aspects of their treatment program and setting in which treatment will be received. Providing the mechanism for BHIFs to become licensed by the state can provide communities with the opportunity to develop more local mental health treatment options.

The proposed rules address basic BHIF requirements for the application process, staffing requirements, policies and procedures, records, security, physical setting, and environmental considerations.

The rules also address specific requirements more directly relating to the patient including assessments, treatment planning, restraint and seclusion, patient rights, quality assessment, discharge, and transfer to the state hospital.

The department considered several options regarding promulgating rules relating to behavioral health inpatient facilities. First, was it necessary to have rules specific to behavioral health inpatient facilities? The department determined the rules were necessary due to increased demand for mental health treatment services currently provided in hospital emergency rooms. Individuals who will be served in a behavioral health inpatient facility are now seen in a hospital emergency room at considerable public expense. For those who do require an inpatient level of care a BHIF provides a less expensive alternative for assessment of clinical needs because there is no transportation to and from the state hospital. A BHIF can also make referrals or utilize any appropriate available resources in the community.

Incorporating BHIF requirements into specialty mental health facility rules was also considered by the department but was rejected. While both BHIFs and specialty mental health facilities treat individuals with mental impairments, the treatment needs are too diverse to consolidate both types of facilities into one set of rules. Rules specific to each type of mental health facility will ensure that the rules are neither too restrictive nor permissive in providing appropriate regulation of the facility for the types of clients served.

5. The department intends to apply these rules effective July 1, 2009. In the event the rules are adopted retroactively no negative impact is anticipated.

6. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail [email protected], and must be received no later than 5:00 p.m., June 25, 2009.

7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

8. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 6 above or may be made by completing a request form at any rules hearing held by the department.

9. An electronic copy of this Proposal Notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of the Notice conform to the official version of the Notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the Notice and the electronic version of the Notice, only the official printed text will be considered. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.

10. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The primary bill sponsor was contacted by letter dated May 11, 2009, sent postage prepaid via USPS.

/s/ Lisa Swanson /s/ Anna Whiting Sorrell

Rule Reviewer Anna Whiting Sorrell, Director

Public Health and Human Services

Certified to the Secretary of State May 18, 2009.