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| Montana Administrative Register Notice 37-538 | No. 10 05/26/2011 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons 1. On June 15, 2011, at 10:00 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 amendment and repeal 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 6, 2011, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, 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 amended provide as follows, new matter underlined, deleted matter interlined: 37.87.1303 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: FEDERAL AUTHORIZATION AND AUTHORITY OF STATE TO ADMINISTER PROGRAM (1) through (4) remain the same. (a) Yellowstone County core site, implementation date of October 1, 2007. (i) Service areas of Carbon, Stillwater, Musselshell, and Big Horn Counties added to the Yellowstone County core site, implementation date of October 1, 2010. (b) Missoula and Ravalli Counties core site, implementation date of August 1, 2009. (c) Cascade County core site, implementation date of October 1, 2010. (d) Lewis and Clark County core site, with service areas of Jefferson and Broadwater Counties, implementation date of October 1, 2010. (e) Flathead County core site, implementation date of July 1, 2011. (5) In the service areas specified in (4) (a) When a waiting list is established in any of the core sites, the protocol defined in the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 will be used by the department to reallocate unused service opportunities. (6) remains the same. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1305 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: ELIGIBILITY FOR PROGRAM (1) and (2) remain the same. (3) A youth is eligible to be considered for enrollment in the program if: (a) the youth is age six through (b) the youth is Medicaid eligible; (c) the youth requires the level of care, as determined through the certificate of need process, for a psychiatric residential treatment facility in accordance with (d) through (j) remain the same. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1307 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: LOSS OF A SERVICE AND DISENROLLMENT (1) A service available through the program may be denied to a youth for the following reasons: (a) the service is not appropriate for the youth; (b) a service that is a necessary ancillary to the provision of the service is unavailable; (c) access to the service, even with reasonable accommodation, is precluded by the youth's physical or mental health; or (d) the financial costs and other impacts on the program due to the delivery of the service to the youth do not conform with the plan of care requirements in (2) A youth enrolled in the program may be terminated from the program by the department for the following reasons: (a) through (h) remain the same. (i) the youth no longer requires the level of care of a psychiatric residential treatment facility, (j) through (m) remain the same. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1321 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: THE PROVISION OF SERVICES (1) and (2) remain the same. (3) The following services (a) through (5) remain the same. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1333 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: REIMBURSEMENT (1) remains the same. (2) Program services are reimbursed at the lower of the following: (a) the provider's usual and customary charge for the services; or (b) the fees stated in Appendix A with an effective date of August 1, 2011 contained in the program's Psychiatric Residential Treatment Facility Home and Community-Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated (3) and (4) remain the same. (5) A geographical factor of $.50 per mile may be available to a family support specialist, wraparound facilitator, caregiver peer-to-peer specialist, or a home-based therapist when the following circumstances are met: (a) the provider is traveling out of the location where the provider has its regular office, excluding satellite offices; (b) the provider is traveling a distance greater than 35 miles one way from the office to the youth's home; (c) the geographical factor will include the initial 35 miles and return trip; (d) the geographical factor is prior authorized by the plan manager; and (e) the geographical factor and those providers authorized to receive it are included in the youth's plan of care. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 4. The department proposes to repeal the following rules: 37.87.1323 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE AND PLANS OF CARE: PLAN MANAGEMENT, is found on page 37-21403 of the Administrative Rules of Montana.
AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1338 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: CONSULTATIVE CLINICAL AND THERAPEUTIC SERVICES, REQUIREMENTS, is found on page 37-21415 of the Administrative Rules of Montana.
AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1339 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: CUSTOMIZED GOODS AND SERVICES, REQUIREMENTS, is found on page 37-21415 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1340 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: EDUCATION AND SUPPORT SERVICES, is found on page 37-21416 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1341 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: HOME-BASED THERAPY SERVICES, REQUIREMENTS, is found on page 37-21416 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1342 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: NONMEDICAL TRANSPORTATION, is found on page 37-21417 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1343 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: RESPITE CARE SERVICES, is found on page 37-21417 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1344 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: FAMILY SUPPORT SPECIALIST SERVICES, is found on page 37-21418 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1345 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: CAREGIVER PEER-TO-PEER SUPPORT SPECIALIST, is found on page 37-21419 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 37.87.1346 HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE: WRAPAROUND FACILITATION SERVICES, is found on page 37-21420 of the Administrative Rules of Montana. AUTH: 53-2-201, 53-6-113, 53-6-402, MCA IMP: 53-6-402, MCA 5. Statement of Reasonable Necessity: The Department of Public Health and Human Services (the department) is proposing to amend the above-stated administrative rules pertaining to Home and Community-Based Services for Youth with Serious Emotional Disturbance. Following is a detailed description of each proposed rule amendment. ARM 37.87.1303
The department is proposing to amend ARM 37.87.1303 as follows: Yellowstone County is now listed as a core site and adds the service areas of Carbon, Stillwater, Musselshell, and Big Horn Counties, with an implementation date of October 1, 2010; Missoula and Ravalli Counties are now listed as core sites; Cascade County is now listed as a core site, with an implementation date of October 1, 2010; Lewis and Clark County is now listed as a core site and adds the service areas of Jefferson and Broadwater Counties with an implementation date of October 1, 2010; and Flathead County as a core site with an implementation date of July 1, 2011. Proposed changes to this rule also include: stating when a waiver year begins and ends; and clarifying that accumulatively in all service areas no more than a total of 100 youth may be enrolled at any given time; and adds that the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 will be used by the department to reallocate unused service opportunities when a waiting list has been established in any of the sites. The proposed amendments are necessary to reflect the amendment to the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance (Waiver) that was approved by the Centers for Medicare and Medicaid Services. The department chose to add the counties and the waiting list reference in the administrative rules in order for youth, advocates, families, and providers to know what counties in Montana have this particular waiver available as well as the potential for reallocation of service opportunities once a waiting list is established. The department opted for this approach rather than leaving the defined counties and potential reallocation of service opportunities out of the rule as it seemed unreasonable to not include the newly added counties when the other counties are already listed in the rule. The waiting list and potential reallocation of service opportunities are outlined in the federally approved waiver. ARM 37.87.1305
The department proposes to amend ARM 37.87.1305 by updating the age that a youth is eligible to be considered for enrollment in the program from age "six through 16" to age "six through 17", and from the 17th to the 18th birthday. Another amendment to this rule adds the Children's Mental Health Bureau Provider Manual and Clinical Guidelines for Utilization Management, included in ARM 37.87.903, as the cite for the determination of level of care for a psychiatric residential treatment facility for the youth to be considered for enrollment in the program. The proposed amendments are necessary to reflect the accurate upper age limit for youth as well as accurately reflect the manual regarding level of care criteria. The department updated the age of the youth through 17 up to the 18th birthday because this was overlooked in a previous rule amendment. The language in the rules for the youth's age is now consistent. The department made this change to avoid any confusion within the rules regarding the upper age limit criteria. The department chose to reference the Children's Mental Health Bureau Provider Manual and Clinical Guidelines for Utilization Management included in ARM 37.87.903 to avoid misleading information for providers, youth, families, and staff regarding the level of care criteria. ARM 37.87.1307
The department proposes to amend ARM 37.87.1307(1)(d) which references the plan of care requirements in accordance with the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010. ARM 37.87.1307(2)(i) is also being amended which references the Children's Mental Health Bureau Provider Manual and Clinical Guidelines for Utilization Management, included in ARM 37.87.903 regarding the level of care criteria for a psychiatric residential treatment facility. The proposed changes are necessary for an accurate reflection of the most up-to-date manuals. The plan of care criteria is being proposed to be part of the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010. By having the criteria in the manual, providers will be more familiar with the plan of care requirements. The department incorporates by reference the Children's Mental Health Bureau Provider Manual and Clinical Guideline for Utilization Management included in ARM 37.87.903. The proposed amendment references this manual's location in ARM. The department decided to move the plan of care criteria to the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 so providers (for example, wraparound facilitators) are more familiar with the plan of care requirements. The department could have left the plan of care requirements in the rules, but proposes to move them to the provider policy manual in order for providers to be more compliant. The department is incorporating by reference the Children's Mental Health Bureau Provider Manual and Clinical Guideline for Utilization Management included in ARM 37.87.903. The department is proposing this action to alleviate any confusion by providers, consumers, advocates, staff, or public.
ARM 37.87.1321
The department proposes to amend ARM 37.87.1321(3) by adding language for the "following services" as defined and incorporated by reference in the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010. At this time, the department is proposing to make the Administrative Rules of Montana (ARM) for this waiver program more user-friendly by striking the language in the ARM and moving it to the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010. The department proposes this option to make the provider policy manual a more useful document for providers, consumers, advocates, and the public.
ARM 37.87.1333 The department proposes to amend ARM 37.87.1333(2)(b) by updating the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010; states the Developmental Services Division is the division where the Children's Mental Health Bureau is located; and updates the physical and mailing address to 111 North Sanders and P.O. Box 4210, Helena, MT 59604-4210. The department proposes to amend ARM 37.87.1333(5) by adding new language which states a geographical factor of $.50 per mile may be available to a family support specialist, wraparound facilitator, caregiver peer-to-peer specialist, or a home-based therapist under certain circumstances as outlined in the rule. The proposed amendments are necessary to reflect the current version of the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010, update the division name and location of the Children's Mental Health Bureau, and describe the geographical factor of $.50 per mile for defined waiver providers as well as the eligibility criteria for its availability. The department is proposing to update the current version of the provider manual, update the division name and address, to avoid any confusion for providers, consumers, families, advocates, or general public. The department is proposing the geographical factor in the rule so those providers affected by the geographical factor are familiar of this means to build capacity for said waiver providers who must travel to outlying areas. Without describing and defining the geographical factor, waiver providers may be reluctant to serve youth and their families in outlying areas.
ARM 37.87.1323, 37.87.1338, 37.87.1339, 37.87.1340, 37.87.1341, 37.87.1342, 37.87.1343, 37.87.1344, 37.87.1345, and 37.87.1346
In order to make the administrative rules for this waiver program more user-friendly the department is proposing repealing these rules and moving the information to the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010. The department is proposing repeal of these rules and incorporation of the provider policy manual to provide a one-stop source of information for providers, consumers, advocates, and the public. Consumers are more attuned to viewing the information in the manual. The department believes it may be easier and less confusing to organize this information in a manual instead of referring to the nine separate administrative rules. Persons and Entities Affected, Fiscal Effects At capacity, 100 youth may be enrolled in the waiver at any given time; the cost of the waiver must be less than or equal to the cost of serving the youth in a PRTF facility. The number of persons affected: 100 youth at any given time in the waiver in the counties where the waiver is available. There are approximately 61 enrolled waiver providers in Montana. There is no anticipated fiscal impact from these rules. Use of any particular waiver service is governed by the need of the individual youth being served 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: Kenneth Mordan, 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 23, 2011. 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, do not apply.
/s/ John Koch /s/ Anna Whiting Sorrell Rule Reviewer Anna Whiting Sorrell, Director Public Health and Human Services Certified to the Secretary of State May 16, 2011.
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A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact [email protected].
