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| Montana Administrative Register Notice 37-619 | No. 23 12/06/2012 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons 1. On December 26, 2012, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed adoption, 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 December 19, 2012, 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 adopted provide as follows: NEW RULE I HOME SUPPORT SERVICES AND THERAPEUTIC FOSTER CARE, SERVICES REIMBURSEMENT (1) Reimbursement for the therapeutic portion of home support services (HSS) and therapeutic foster care (TFC) services is the lesser of: (a) the amount specified in the department's fee schedule adopted in ARM 37.87.901; or (b) the provider's usual and customary charges. (2) HSS and TFC providers must use the procedure codes designated by the department, in the fee schedule referred to in (1)(a) to be reimbursed for HSS and TFC. (3) HSS and TFC providers are reimbursed a daily or patient day rate. Patient day means a whole 24-hour period that a youth is present and receiving HSS or TFC services. Even though a youth may not be present for a whole 24-hour period, the day of admission is a patient day. The day of discharge is not a patient day. (4) Medicaid will not reimburse for room, board, maintenance, or any other nontherapeutic component of HSS or TFC treatment, including when this service is delivered in a foster home. (5) Targeted case management will not be reimbursed concurrently with HSS or TFC. NEW RULE II HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), DEFINITIONS (1) "Behavioral Aide" means for therapeutic foster care permanency, an unlicensed employee of the mental health center who works under the supervision of the licensed mental health professional. All behavioral aides must have, at a minimum, a high school diploma and at least two years of experience working with emotionally disturbed youth or providing direct services in a human services field. Aides may only provide services for which they have demonstrated competency and which are not limited to the scope and practice of the licensed mental health professional. (2) "Caregiver" means a person responsible for the well-being of the youth on a day-to-day basis with written permission from the legal representative of the youth, when applicable. (3) "Clinical lead" means a person who is an employee of the provider agency who is responsible for the supervision and overall provision of treatment services to youth in HSS and TFC. Effective January 31, 2014, the clinical lead must be a licensed mental health professional as defined in ARM 37.87.702 or an in-training practitioner as defined in ARM 37.88.901. (4) "Concurrent" means any time during the 90-day period of the individualized treatment plan for HSS and TFC, unless the youth is discharged from service. (5) "Home support services (HSS)" and "therapeutic foster care (TFC)" means medically necessary, intensive in-home services delivered by providers with specialized training and experience working with caregivers and youth in their homes, with temporary services available when a youth is homeless for less than 90 days. (6) "Home support services specialist" means a person who is an employee of the provider agency who provides therapeutic interventions to youth who are receiving HSS and TFC. The home support services specialist (HSS-S) must have a bachelor's degree in a human services field, or a combination of experience and education equivalent to a bachelor's degree. For a HSS-S, six years of human services experience equates to a bachelor's degree and each year of post-secondary education in human services equates to one year experience. NEW RULE III HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), INDIVIDUALIZED TREATMENT PLAN (1) The individualized treatment plan (ITP) must be developed in accordance with ARM 37.106.1916 and based upon a strengths, needs, and cultural assessment of the caregiver and the youth. (2) The caregiver may select the members of the ITP team. (3) Providers must inform the youth and their caregiver that Medicaid requires coordination of HSS and TFC with comprehensive school and community treatment (CSCT) planning, when applicable. (4) The licensed person on each treatment team must sign the ITP of other services the youth, caregiver, or both are receiving. (5) The ITP is in place for 90 days unless the youth is discharged. NEW RULE IV HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), ASSESSMENTS (1) A clinical assessment consistent with ARM 37.106.1915 must be completed for each youth documenting the youth has a severe emotional disturbance as defined in ARM 37.87.303. (2) If a youth has received a clinical assessment as described in (1) within the past 12 months, a copy of the clinical assessment will be accepted. (3) A clinical assessment must be completed annually. (4) A functional assessment identifying potential crisis situations must be completed for each youth within the first 14 days after intake. The functional assessment must: (a) include a specific plan to respond to each identified crisis; and (b) be updated every 90 days. NEW RULE V HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), PROVISIONS OF SERVICE (1) The main focus of the service is to address the mental health needs and strengthen the structure and support for youth and the caregivers. HSS and TFC serve the youth and the caregivers in their home and community environment through understanding the needs of the youth and the dynamics of the caregivers. HSS and TFC requires a structured, consistent, strength based therapeutic relationship between the provider and the youth and the caregiver for the purpose of treating the behavioral health needs of the youth, including improving the caregiver's ability to provide effective support for the youth and to promote healthy functioning. (2) The following must be available and provided as clinically indicated by a mental health professional and in accordance with ARM 37.87.903: (a) conduct a treatment team meeting with the caregiver to develop an individualized treatment plan in accordance with [New Rule II]; (b) write treatment summaries at a minimum of every month describing progress and changes in the strengths and needs of the youth and the caregiver to inform service provisions; and (c) develop a crisis plan with the caregiver that identifies a range of potential crisis situations with a range of corresponding responses including direct (face-to-face) and telephonic responses 24/7. (3) The following services, identified in the individualized treatment plan, must be available and provided as clinically indicated: (a) individualized therapeutic support to the youth and the caregiver based on strengths and needs; (b) identification, coordination, and strengthening of formal and informal supports; and (c) post-crisis consultation and crisis plan revision with the team and the caregiver, as needed. (4) The following services must be available and provided as clinically indicated. The services must be identified in the ITP and include two of the following: (a) skill building; (b) assistance for the youth and the caregiver to identify resources to meet their needs; (c) therapy delivered to the caregiver and family by the clinical lead; (d) instruction for the caregiver on behavior management strategies; and (e) psycho-educational programs. NEW RULE VI HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), DISCHARGE PLANNING AND DOCUMENTATION (1) The youth may be discharged from this level of care based upon at least one the following criteria: (a) the caregiver no longer needs this level of support or is actively using other formal and informal support networks; (b) the treatment plan for the youth indicates the goals and objectives for the services have been substantially met; (c) the caregiver is not engaged in the services. The lack of engagement is of such a degree that this type of support becomes ineffective or unsafe, despite documented attempts to address the engagement issues; (d) the caregiver withdraws consent for the treatment; (e) the youth is placed in a residential treatment setting with no plan for return to the home setting; or (f) the youth has moved to an independent living situation and is no longer in or returning to the family setting. (2) A discharge summary must be documented and indicate the reason for the discharge. NEW RULE VII HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), PROVIDER REQUIREMENTS (1) HSS and TFC providers must be a mental health center as described in Title 37, chapter 106, subchapter 19. (2) Providers of therapeutic foster care must also be a child placing agency. (3) A full-time clinical lead is responsible for not more than five full-time home support services specialists (HSS-S). (4) The clinical lead must: (a) provide direction and consultation to the HSS-S to address the clinical needs of the youth and the caregiver as identified in the individualized treatment plan (ITP); (b) provide therapy to the caregiver and family when identified as a need in the ITP; (c) respond to the youth and the caregiver's needs when the HSS-S is not available; (d) orient, train, and coach the HSS-S; and (e) provide one-on-one supervision at least monthly to the HSS-S. (5) A full-time HSS-S is responsible for not more than ten youths at a time. (6) The following requirements must be met by either the clinical lead or the HSS-S or both: (a) provide contacts at the frequency, location, and duration that are sufficient to meet the identified needs of the youth and the caregiver, the duration of the contacts are not limited; (b) conduct a minimum of four scheduled contacts or sessions with the caregiver in each four-week period, two of which must be face-to-face, based on the needs of the caregiver and documented in the ITP; and (c) conduct a minimum of two scheduled face-to-face treatment sessions with the youth in each four-week period, based on the needs of the youth and documented in the ITP. (7) 24/7 face-to-face and telephonic crisis response is expected. (8) Providers of HSS and TFC must use a research-based practice curriculum specific to provide family-based services. Staff training in the research-based practice must be documented in the provider personnel records. NEW RULE VIII COMMUNITY-BASED PSYCHIATRIC REHABILITATION SUPPORT SERVICES: (1) Community-based psychiatric rehabilitation support (CBPRS) services are provided on a face-to-face basis primarily with a youth, and may also include consultation on a face-to-face basis with family members, teachers, employers, or other key individuals in the youth's life when such contacts are clearly necessary to meet rehabilitation goals established in the youth's individual treatment plan. CBPRS services: (a) may only be provided when the youth is receiving other mental health services; (b) require prior authorization by the department or its designee when provided for a youth in the PRTF waiver during day treatment program hours; (c) do not require prior authorization when provided on the same day as CSCT, Day Tx, or partial hospital services, if CBPRS is provided before or after program hours. This includes both individual and group CBPRS. Documentation of CBPRS must include time in and time out to show that CBPRS was not provided during program hours; (d) are not allowed when the service to be provided is: (i) during day treatment program hours unless the youth is in the PRTF waiver and CBPRS services are prior-authorized; (ii) during CSCT or partial hospital program hours; (iii) provided by a licensed mental health professional; (iv) for the purpose of habilitation, academic instruction, recreation, vocational, or prevocational training; (v) in a therapeutic group home, hospital, psychiatric residential treatment facility, or other residential facilities; (vi) case planning activities such as attending meetings, completing paperwork, and other documentation requirements or travel time; and (vii) solely for the purpose of safety. (e) may not exceed the following limits for group: (i) up to a maximum of two hours per day; (ii) up to a maximum of eight youth per group; and (iii) up to a staff ratio of four youth to one staff. NEW RULE IX THERAPEUTIC FOSTER CARE PERMANENCY SERVICES, AUTHORIZATION REQUIREMENTS AND COVERED SERVICES (1) The therapeutic and rehabilitative portion of medically necessary therapeutic foster care permanency (TFOC-P) services is covered if prior-authorized by the department or its designee according to the provisions of the Children's Mental Health Bureau's (CMHB) Provider Manual and Clinical Guidelines for Utilization Management incorporated in ARM 37.87.903 and this subchapter. TFOC-P providers are required to abide by the CMHB Provider Manual and Clinical Guidelines for Utilization Management. (2) Medicaid reimbursement is not available for TFOC-P services unless the provider submits to the department or its designee in accordance with this subchapter and the CMHB Provider Manual and Clinical Guidelines for Utilization Management, a complete and accurate CON that certifies the level of care needed for the youth with a serious emotional disturbance (SED). (3) For youth determined Medicaid eligible by the department at the time of admission to TFOC-P services, the CON required under (2) must be: (a) completed, signed, and dated prior to, but no more than 30 days before, admission; and (b) written by a team of health care professionals that has competence in diagnosis and treatment of mental illness, and that has knowledge of the youth's situation, including the youth's psychiatric condition. The team must include a physician that has competence in diagnosis and treatment of mental illness, preferably in child psychiatry, and a licensed mental health professional as defined in ARM 37.87.102. (4) All CONs required under (2) must actually and personally be signed by a minimum of two team members. Two of the signatures must be: (a) a physician who has competence in diagnosis and treatment of mental illness, preferably child psychiatry, or a board-certified/board-eligible psychiatrist; and (b) a licensed mental health professional. If a signature stamp is used, the team member must actually and personally initial the document over the signature stamp. (5) The therapeutic portion of TFOC-P services, as defined by [New Rule V], is covered if provided by a TFOC-P agency licensed by and contracted with the department to provide TFOC-P services. NEW RULE X THERAPEUTIC FOSTER CARE PERMANENCY SERVICES, PROVIDER PARTICIPATION (1) Therapeutic foster care permanency (TFOC-P) services must be provided in accordance with [New Rules I through VII] (HSS/TFC). (2) TFOC-P must be provided by a child placement agency in accordance with ARM Title 37, chapter 93. (3) TFOC-P is an intensive level of treatment for youth in a therapeutic foster family placement which is permanent and includes: (a) individual, family, and group therapies; (b) clinical supervision provided by a licensed psychologist on a 1:20 ratio; (c) a treatment manager who is a masters or bachelors level social worker with three years' experience, on a 1:6 ratio; (d) behavioral aide services averaging at least ten hours per week; (e) respite care at least one weekend per month; and (f) additional specialized training for families. 4. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined: 37.87.703 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), COVERED SERVICES (1) Mental health center services for youth with serious emotional disturbance include: (a) Community-based psychiatric rehabilitation and support (CBPRS) services (b) through (f) remain the same. (g) Mental health professional services, which include the professional component of physician or psychiatrist services covered in ARM 37.86.101, 37.86.104, and 37.86.105 AUTH: 53-2-201, 53-6-101, 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-111, MCA 5. The department proposes to repeal the following rules: 37.37.301 THERAPEUTIC FAMILY CARE, DEFINITIONS, is found on page 37-8115 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, MCA 37.37.303 THERAPEUTIC FAMILY CARE, COMPLIANCE WITH APPLICABLE REQUIREMENTS, is found on page 37-8119 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, 52-1-103, MCA 37.37.310 THERAPEUTIC FAMILY CARE, LEVELS OF SERVICE, is found on page 37-8123 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, MCA 37.37.311 THERAPEUTIC FAMLY CARE, STAFF, is found on page 37-8125 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, MCA 37.37.316 THERAPEUTIC FAMILY CARE, TREATMENT PARENTS, is found on page 37-8129 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA 37.37.318 THERAPEUTIC FAMILY CARE, MEDICAL NECESSITY, ADDITIONAL TRAINING REQUIREMENTS, is found on page 37-8130 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, 52-1-103, 52-2-111, 52-2-601, 52-2-621, 52-2-622, MCA 37.37.323 THERAPEUTIC FAMILY CARE, INDIVIDUAL TREATMENT PLAN, is found on page 37-8135 of the Administrative Rules of Montana. AUTH: 41-1-1103, 52-1-103, 52-2-111, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, MCA 37.37.330 THERAPEUTIC FAMILY CARE, WELL-CHILD SCREENING, AND CHEMOTHERAPY, is found on page 37-8143 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, MCA 37.37.336 THERAPEUTIC FAMILY CARE, MEDICAL NECESSITY, ADDITIONAL CASE RECORDS, is found on page 37-8149 of the Administrative Rules of Montana. AUTH: 41-3-1103, 52-1-103, 52-2-111, MCA IMP: 41-3-1103, 41-3-1105, 41-3-1122, MCA 37.87.1021 THERAPEUTIC FAMILY CARE (TFC) AND THERAPEUTIC FOSTER CARE (TFOC) SERVICES REIMBURSEMENT, is found on page 37-21356 of the Administrative Rules of Montana. IMP: 53-2-201, 53-6-101, 53-6-111, MCA 37.87.1023 THERAPEUTIC FAMILY CARE (TFC) AND THERAPEUTIC FOSTER CARE (TFOC) SERVICES, AUTHORIZATION REQUIREMENTS AND COVERED SERVICES, is found on page 37-21357 of the Administrative Rules of Montana. IMP: 53-2-201, 53-6-101, 53-6-111, MCA 37.87.1025 THERAPEUTIC FAMILY CARE (TFC) AND THERAPEUTIC FOSTER CARE (TFOC) SERVICES, DEFINITION OF PERMANENCY TFOC TREATMENT, is found on page 37-21359 of the Administrative Rules of Montana. IMP: 53-2-201, 53-6-101, 53-6-111, MCA 6. STATEMENT OF REASONABLE NECESSITY Home Support Services The Department of Public Health and Human Services (the department) is proposing rule changes to update outdated therapeutic foster care, moderate level; therapeutic foster care-permanency level; and therapeutic family care rules to align with the department's mission of supporting best practices and outcomes for youth and caregivers. The Children's Mental Health Bureau (CMHB) reviewed a sample of Therapeutic Foster Care (TFOC) and Therapeutic Family Care (TFC) services across the state beginning in April 2011. CMHB gathered information through a semistructured, team-administered series of Service Review (SR) tools. The process began by gathering qualitative information through interviews with multiple stakeholders to better understand how TFC and TFOC programs are being provided. CMHB convened a workgroup of department staff and provider stakeholders to develop proposed rule language and engage in dialogue regarding key policy decisions. CMHB conducted analysis of services through the claims payment system to understand current service utilization and cost analysis. Analysis included reviewing how current services are billed with other mental health state plan services. These proposed new rules, amendments, and repeals are necessary to implement the policies and billing practices. The department is repealing multiple rules, reorganizing, and proposing new rules to provide clear guidelines of service expectations. The rule changes promote youth and caregiver's access to family therapy within current reimbursement and endorse youth and caregiver agreement to services. The department is changing the service names from therapeutic family care to home support services (HSS), and therapeutic foster care, moderate level to therapeutic foster care (TFC). Additionally, the proposed rules disallow for targeted case management (TCM) concurrent with HSS, TFC, and therapeutic foster care-permanency services. The proposed changes also allow HSS to be billed by a licensed mental health center. New Rules I through VII, Home Support Services
The department is proposing new rules to the CMHB section of department rules Title 37, chapter 87 regarding home support services, formally therapeutic family care, and therapeutic foster care. The proposed rules promote youth and caregiver's access to family therapy within current reimbursement and endorse youth and caregiver agreement to services. The department is changing the service names from therapeutic family care (TFC) to Home Support Services (HSS), and therapeutic foster care-moderate (TFC-M) to TFOC. Additionally, the proposed rules close gaps of service duplication by proposing targeted case management (TCM) is not a reimbursable Medicaid service concurrent with HSS, TFC, and TFOC-P services. New Rule I The department proposes New Rule I to describe the requirements for reimbursement of home support services and therapeutic foster care. This is necessary to provide basic information for providers to follow regarding the reimbursement process. New Rule II The department is proposing New Rule II in order to define common terminology used in reference to home support services and therapeutic foster care. This is necessary in order to ensure consistent use of common terminology and to avoid ambiguity that might confuse providers. New Rule III The department is proposing New Rule III which further describes the requirements for the individual treatment plan. ARM 37.106.1916 provides the minimum requirements for the individualized treatment plan. This rule is necessary to provide detailed requirements for this program. New Rule IV The department is proposing New Rule IV. This rule is necessary to provide guidance to providers on the required assessments for youth entering home support services and therapeutic foster care. New Rule V The department proposes New Rule V to address the provision of service. This rule is necessary to supply providers with the necessary service requirements so that they may provide the most valuable and appropriate services to the families they serve. New Rule VI The department is proposing New Rule VI regarding discharge planning and documentation. This rule is necessary to provide the criteria in which a youth may be discharged from the program and to explain to providers the documentation that is required in the event a youth is discharged. New Rule VII The department is proposing New Rule VII, provider requirements. This rule is necessary to establish the guidelines providers must adhere to in licensing as well as staffing requirements necessary for Medicaid reimbursement. New Rule VIII The department is proposing New Rule VIII in order to create a rule for community-based psychiatric rehabilitation and support (CBPRS) services. This language is currently located in ARM 37.87.703(1)(a) as a covered service. The department believes that by creating a separate rule for this service, providers and the public have improved accessibility to the information contained in the rule. NEW RULES IX AND X, Therapeutic Foster Care-Permanency The department is proposing New Rules IX and X to move the content of the current rules regarding therapeutic foster care-permanency in ARM 37.87.1021, 37.87.1023, and 37.87.1025 to the corresponding new program section in the CMHB subchapter for consistency and easy reference for all stakeholders. ARM 37.37.301, 37.37.303, 37.37.310, 37.37.311, 37.37.316, 37.37.318, 37.37.323, 37.37.330, and 37.37.336 The department is proposing to repeal ARM 37.37.301, 37.37.303, 37.37.310, 37.37.311, 37.37.316, 37.37.318, 37.37.323, 37.37.330, and 37.37.336. The rules listed are inconsistent with Medicaid payment rules and focus on home-based foster services. Medicaid reimburses mental health services to both foster and biological families. Some requirements aimed at defining the service do not apply to biological families. CMHB administers the medically necessary mental health portion of home-based services and will administer payment rules in the CMHB chapter of department rules. These rules need to be updated to allow CMHB to administer the mental health component of home-based services without referencing rules that do not apply to the mental health service component. Child Protective Services and the Quality Assurance Division, who license child placement agencies, reviewed potential impacts and rule references to the above rules and agreed they should be repealed. ARM 37.87.1021, 37.87.1023, and 37.87.1025 The department is proposing to repeal ARM 37.87.1021, 37.87.1023, and 37.87.1025 and to move the content of the rules to the corresponding new program section in the CMHB Title 37, chapter 87 for consistency and easy reference for all stakeholders. ARM 37.87.703 The department is proposing amendments to ARM 37.87.703 to allow for HSS to be reimbursed by a licensed mental health center and also requires therapeutic foster care (TFC) and therapeutic foster care-permanency (TFOC-P) to be provided only by a provider that is both a licensed mental health center and a child placing agency (CPA). This is necessary because mental health centers (MHC) have minimum requirements promoting quality mental health services and should provide home-based mental health services to biological families and HSS services aimed at biological families. Child placing agency (CPA) rules are not aligned with mental health quality measures and are aimed at the foster care service. TFC and TFC-P need both foster service requirements and quality mental health measures and are thus required to be provided by an entity that is both a MHC and CPA. Fiscal Impact for Home Support Services 1,350 plus clients received home support services (HSS), formerly therapeutic family care (TFC) in State Fiscal Year (SFY) 2012. Approximately 50% to 60% or about 700 youth received HHS and also receive family therapy outside the HHS and TFC bundle. Approximately 1,000 youth received HSS and targeted case management concurrently in SFY 2012. Ten of 18 mental health centers are currently enrolled Medicaid HSS/TFC providers; eight additional mental health centers could potentially start billing HSS services. The estimated combined expenditure for the proposed rule changes may be up to $750,000. 7. 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., January 3, 2013. 8. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing. 9. 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 7 above or may be made by completing a request form at any rules hearing held by the department. 10. 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. 11. 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 November 26, 2012.
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