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 III, the amendment of ARM 37.106.1902, 37.106.1906, 37.106.1916, 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965, and the repeal of ARM 37.86.2224 and 37.86.2225, pertaining to comprehensive school and community treatment program (CSCT)

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NOTICE OF ADOPTION, AMENDMENT, AND REPEAL

 

TO:  All Concerned Persons

 

1.  On December 20, 2012, the Department of Public Health and Human Services published MAR Notice No. 37-621 pertaining to the public hearing on the proposed adoption, amendment, and repeal of the above-stated rules at page 2551 of the 2012 Montana Administrative Register, Issue Number 24.

 

2.  The department has amended ARM 37.106.1902, 37.106.1906, 37.106.1916, and 37.106.1960 as proposed.  The department has repealed ARM 37.86.2224, and 37.86.2225 as proposed.

 

3.  The department has adopted the following rules as proposed with the following changes from the original proposal.  Matter to be added is underlined.  Matter to be deleted is interlined.

 

            NEW RULE I (37.87.1801)  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM:  REFERRALS  (1)  Comprehensive school and community treatment (CSCT) services must be provided as set forth in ARM 37.106.1916, 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965 in order to receive payment under this program.

            (2)  Youth referred to the CSCT program must be served in sequential order as determined by the priority order priorities below based upon acuity and need, regardless of payer:

            (a)  without treatment, the youth is may become at risk of self-harm or harm to others;

            (b)  the youth requires support for transition from intensive out-of-home or community-based services;

            (c)  the youth meets the serious emotional disturbance criteria;

            (d)  the youth has not responded to positive behavior interventions and supports;

            (e)  the youth is not attending school due to the mental health condition of the youth; or.

(f)  effective July 1, 2014, the needs and strengths of the youth identified by the child and adolescent needs and strengths (CANS) assessment are such that without mental health services the youth will not be able to make positive behavioral changes.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            NEW RULE II (37.87.1802)  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM:  CONTRACT REQUIREMENTS  (1) and (2) remain as proposed.

            (3)  The school must identify:

            (a) remains as proposed.

            (b)  the role of the school counselor and the school psychologist, as appropriate, in the provision of mental health services and supports to youth including coordination with the CSCT program; and

            (c)  the space provided and program supports, including telephone, computer access, locking file cabinet(s), and copying, that the school will make available to CSCT staff while providing services within the school.;  The treatment space provided must be adequate and appropriate for confidentiality, privacy, and the services provided.

            (d)  office space dedicated to CSCT which must be adequate and appropriate for confidentiality and privacy for the services provided; and

            (e)  treatment space available to CSCT large enough to host a group during both school and nonschool days.

            (4)  The school and mental health center must specify a referral process to the CSCT program that ensures youth have access to services prioritized according to acuity and need as specified in [NEW RULE I].

            (5)  The school and mental health center must specify an enrollment process that:

            (a)  includes the CSCT licensed or in-training mental health professional and a school administrator or designee;

            (b)  ensures youth have access to services prioritized according to acuity and need as specified in ARM 37.87.1801; and

            (c)  considers the current caseload of the CSCT program in terms of a wait list and near-term discharges.

            (5)(6)  The school must describe the implementation of a school-wide positive behavior intervention and supports program, including, at a minimum, the following procedures:

            (a) through (c) remain as proposed.

            (6) through (9) remain as proposed, but are renumbered (7) through (10).

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            NEW RULE III (37.87.1803)  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM:  REIMBURSEMENT  (1)  Comprehensive school and community treatment (CSCT) services provided delivered by a licensed mental health center with an endorsement under ARM 37.106.1955 must be billed under the school district's provider number.  Mental health services that are provided concurrently with CSCT are billed under the mental health center's provider number.  Outpatient therapy codes may not be billed to Medicaid by CSCT staff concurrent with Medicaid for CSCT.

            (2)  CSCT services may be provided to:

            (a)  youth ages three through five who are receiving special education services from the public school in accordance with an individualized education program (IEP) under the Individuals with Disabilities Education Act (IDEA) or attending a preschool program offered through a public school; and

            (b) remains as proposed.

            (3)  One team with two full-time employees may bill no will not be reimbursed for more than 720 billing units per team per month.  Services must be billed in for the month the service is provided.  The licensed or in-training mental health professional must provide at least half of the units billed by the team each month.  Billing units are calculated based on the sum total of minutes each professional spent with the youth per day.

            (4)  Up to 20 CSCT units per youth, per state fiscal year, may be billed for a brief intervention, assessment, or referral and if necessary, referral to other services for youth referred to the CSCT program, regardless of the diagnosis of the youth.  There is no limit on the number of youth that may be served.  These units must be billed as part of the 720 unit monthly team total.

            (5) remains as proposed.

            (6)  The school district as a Medicaid provider of CSCT is subject to all Medicaid state and federal billing rules and regulations.  The school district must:

            (a)  use a sliding fee schedule for youth not eligible for Medicaid;

            (b) and (c) remain as proposed, but are renumbered (a) and (b).

            (7)  The school district or the contracted provider must bill for youth not eligible for Medicaid, the school district may use a sliding-fee schedule.

            (7) remains as proposed, but is renumbered (8).

            (8)(9)  The school district must provide to the department:

            (a)  a copy of the certification of match documentation as required by the department, annually;

            (b) through (d) remain as proposed.

            (9)(10)  Failure to provide documentation to the department in accordance with reporting requirements in (8) (9) may result in:

            (a) and (b) remain as proposed.

(10)(11)  The school must submit to the department an annual report prepared jointly by the school and the mental health center regarding the effectiveness of the CSCT program as determined in ARM 37.106.1956(9).

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

4.  The department has amended the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

            37.106.1955  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM (CSCT) ENDORSEMENT REQUIREMENTS  (1) and (2) remain as proposed.

            (3)  As of July 1, 2014, the child and adolescent needs and strengths (MT CANS) assessment must be initiated for each youth with serious emotional disturbance (SED) referred to enrolled to receive services in the CSCT program within fourteen calendar days of receipt of a referral cosigned signed by the person referring the youth and by a parent or legal representative/guardian of the youth.  The MT CANS must be:

            (a) through (4) remain as proposed.

 

AUTH:   53-2-201, 53-6-113, MCA

IMP:      50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.106.1956  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM (CSCT), SERVICES AND STAFFING         (1)  The CSCT program must be able to provide the following services, as clinically indicated, to youth as outlined in the individualized treatment plan (ITP):

            (a) through (e) remain as proposed.

            (f)  treatment plan coordination with chemical dependency substance use disorder and mental health treatment services the youth receives outside the CSCT program;

            (g) and (h) remain as proposed.

            (i)  continuous treatment that must be available twelve months of the year.  The program must provide a minimum of four hours per week 16 hours per month of CSCT services in summer months and during winter and spring break.

            (2)  CSCT services for youth with serious emotional disturbance (SED) must be provided according to an individualized treatment plan designed by a licensed or in-training mental health professional who is a staff member of a CSCT program team.

            (3)  The CSCT ITP team must include:

            (a)  licensed or in-training mental health professional;

            (b) through (6) remain as proposed.

            (7)  Each CSCT team must include a full-time equivalent mental health professional, who may be an a licensed or in-training mental health professional, as defined in ARM 37.87.702(3).  In-training mental health professionals must be:

            (a) and (b) remain as proposed.

            (8)  Each CSCT team must include a full-time equivalent behavioral aide.  A behavioral aide must work under the clinical oversight of a licensed mental health professional and provide services for which they have received training that do not duplicate the services of the licensed or in-training mental health professional.  All behavioral aides initially employed after July 1, 2013 must have a high school diploma or a GED and at least two years:

            (a) through (c) remain as proposed.

            (9)  The licensed mental health center CSCT program supervisor and an appropriate school district representative must meet at least every 90 days during the time period CSCT services are provided to mutually assess program effectiveness utilizing the following indicators:

            (a) and (b) remain as proposed.

            (c)  CSCT program referrals;

            (d) through (f) remain as proposed.

 

AUTH:    53-2-201, 53-6-113, MCA

IMP:       50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.106.1961  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT (CSCT) PROGRAM, RECORD REQUIREMENTS         (1)  In addition to any clinical records required in ARM 37.85.414 or elsewhere in these rules, the licensed mental health center's CSCT program must maintain the following records for youth with serious emotional disturbance (SED):

            (a) remains as proposed.

            (b)  a signed verification indicating the parent(s) or legal representative/guardian has been informed that Medicaid requires coordination between CSCT, home support services, and outpatient therapy;

            (b) and (c) remain as proposed, but are renumbered (c) and (d).

            (d)(e)  daily progress notes for each individual therapy session and other direct services provided to the youth and family from each team member that document individual therapy sessions and other direct services provided to the youth and family throughout the day including;:

            (i)  when any therapy or therapeutic intervention begins and ends; and

            (ii)  the sum total number of minutes spent each day with the youth.

            (e) and (f) remain as proposed, but are renumbered (f) and (g).

            (2)  In addition to (1), beginning July 1, 2014, youth records must also include the child and adolescent needs and strengths (MT CANS) assessment results.

            (3)  In addition to any clinical records required in ARM 37.85.414 or elsewhere in these rules, records for youth referred to CSCT regardless of their diagnosis as described in ARM 37.87.1801(4) must include the following:

            (a)  a written referral, cosigned signed by the person referring the youth and by the parent(s)/legal representative/guardian, which documents the reason for the referral;

            (b)  progress notes for each individual therapy session and other direct services provided to the youth and family throughout the day; and

            (c) through (4)(b) remain as proposed.

 

AUTH:    53-2-201, 53-6-113, MCA

IMP:       50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.106.1965  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT (CSCT) PROGRAM, SPECIAL EDUCATION REQUIREMENTS  (1) remains as proposed.

            (2)  The licensed or in-training mental health professional or behavioral aide, as appropriate, must attend the individualized education plan (IEP) meeting when requested by the parent(s)/legal representative/guardian or the school.

 

AUTH:     53-2-201, 53-6-113, MCA

IMP:        50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

5.  The department has thoroughly considered the comments and testimony received.  A summary of the comments received and the department's responses are as follows:

 

COMMENT #1:  A few commenters stated that while they are in support of the prioritization of referrals, they are concerned that comprehensive school and community treatment (CSCT) staff is often too busy to respond to crisis calls and that youth exhibiting self-harm or behavior that is harmful to others would be better served by another crisis response mechanism.  Another commenter asked about the child and adolescent needs and strengths (CANS) assessment being used to prioritize referrals when the CANS assessment is not completed until the youth is enrolled in CSCT.

RESPONSE #1:  The department agrees that requiring CSCT staff to absorb the responsibility of all crisis response in schools is an unreasonable requisite.  While schools may choose to engage CSCT staff's expertise in a true emergency if CSCT staff is available, the department will amend the proposed language to reflect that CSCT staff does not respond to crisis needs as part of the referral system.  The department will remove the CANS assessment as a requirement for prioritization of referrals.  The department is adding "MT" to the acronym "CANS" in order to differentiate the nationwide child and adolescent needs and strength assessment tool from that which has been created specifically for Montana.

COMMENT #2:  Many commenters stated they would like New Rule I (ARM 37.87.1801) to require collaboration between the school district and the CSCT program in determining the acuity and needs of the youth and establishing referrals.  The commenters stated to rely solely on a contract between the two entities could jeopardize the effectiveness of the referral system and risk missing those youth who are at risk but not displaying outward behavioral problems; collaboration will protect the integrity of the referral process.

RESPONSE #2:  The department agrees with the commenters that it would benefit the youth to foster collaboration.  The department will amend the requirement in New Rule II (ARM 37.87.1802) to establish a referral process and describe it in the contract, and require collaboration between the licensed mental health professional and the school delegate as part of the enrollment team who will prioritize the referrals.

COMMENT #3:  Two commenters stated that the proposed New Rule I (ARM 37.87.1801) appears to require CSCT programs provide "free care," which is not allowed.  They asked the department to clarify whether or not the department is now requiring CSCT programs to provide "free care" for youth who have no funding for CSCT services.

RESPONSE #3:  New Rule I (ARM 37.87.1801) does not require CSCT programs to provide free care.  New Rule I (ARM 37.87.1801) requires referrals be prioritized according to need, not according to payment source.

COMMENT #4:  A commenter stated that they agree that collaboration is critical to determine youth who may qualify for the CSCT program as well as information sharing.  However, they are concerned about how proposed New Rule I (ARM 37.87.1801) addresses the circumstances when a program is at capacity and has a wait list.

RESPONSE #4:  The department agrees that it is important to take into account current case loads.  The department will amend the proposed language in New Rule II (ARM 37.87.1802) to clarify that the enrollment team will consider the CSCT team's entire caseload, evaluating the likelihood of near-term discharges in the context of a waiting list.  There may also be times that the enrollment team will have to refer the youth to another service provider.

COMMENT #5:  Many commenters argued in favor of more prescriptive rules in regards to transportation and classroom space.

RESPONSE #5:  The department believes it is the responsibility of the school and the mental health center to determine contractually the exact nature of the classroom space and the transportation to the program, particularly on nonschool days.  However, the department understands that privacy is essential for the CSCT program to function effectively and requires space large enough to accommodate a therapeutic group.  Moreover, the provision of a dedicated space to the CSCT program is indicative of a school's willingness to support the CSCT program.  The department will amend New Rule II (ARM 37.87.1802) to be more prescriptive regarding the responsibility of the school to provide office space that is private, dedicated to CSCT, and treatment space large enough to host a group of youth during both school and nonschool days.

COMMENT #6:  Many commenters disagree with the requirement in New Rule III (ARM 37.87.1803) that one team with two full-time employees may bill no more than 720 billing units per team per month because teams regularly bill more than 720 units.  The commenters recommend changing the language to reflect that they are not reimbursed in excess of 720 units per month.  One commenter suggested raising the number of reimbursable units to 800 units per month.

RESPONSE #6:  The department agrees with this comment and will amend the language to state "reimbursed for more than 720 units" rather than "bill for 720 units."  The department does not agree to change the number of reimbursable units.  This would require a rate change and rate setting is outside the scope of this rule notice.

COMMENT #7:  A few commenters asked the department to expand billable services under the existing 720 unit monthly cap.  Among the additional billable service the commenters mentioned were integration, team activities, consultation, coordination, behavior support planning, progress monitoring, and nonface-to-face activities such as family phone therapy.

RESPONSE #7:  The original CSCT rate was designed to include coordination services.  Rate setting is outside the scope of this rulemaking process.

COMMENT #8:  Many commenters asked whether the 20 units for intervention, assessment, and referral are in addition to the 720 reimbursable units allowed each month per team.

RESPONSE #8:  The department will amend the rule to state that 20 units are allowed per youth per state fiscal year (July 1 through June 30) who are without a serious emotional disturbance (SED) diagnosis.  There is not a limit on the number of youth that may be served but it is not in addition to the 720 reimbursable units per month total.  It is optional for the CSCT programs to participate in the intervention, assessment, and referral process for youth who are without a SED diagnosis.

COMMENT #9:  Many commenters asked the department to clarify the rationale that the services must be billed in the month the service is provided.

RESPONSE #9:  The intent of this language is to convey that units cannot be carried over from a previous month.  The department will amend this language.

COMMENT #10:  Many commenters asked the department to reconsider the requirement that the therapist provide at least half of the units allowed each month.  One commenter suggested this requirement precludes the therapist from taking vacations.

RESPONSE #10:  CSCT is a Medicaid mental health service for youth with SED.  Although the behavioral aide provides an extremely important component of the service, youth in the service are expected to follow through with a treatment plan that over time, allows them to cope with the symptoms of SED.  Ethically, a licensed therapist should lead this effort.  Moreover, the service is intended to be comprehensive in scope.  The therapist should be seeing most of the youth on his or her caseload regularly for individual and family therapy.  ARM 37.106.1956(6) allows the program supervisor to fill in for the therapist for short periods of time giving the therapist flexibility when needed.

COMMENT #11:  Many commenters asked the department if the provider of CSCT is the licensed mental health center or the school district.

RESPONSE #11:  CSCT can be provided by either a school district that is a mental health center with an endorsement under ARM 37.106.1955 or a school district that contracts with a mental health center with an endorsement under ARM 37.106.1955.  Either way, the school is the provider.  The department will amend the language to reflect that the school is the provider.

COMMENT #12:  Many commenters asked the department to clarify New Rule III (ARM 37.87.1803) regarding the reimbursement requirements for the school district as a Medicaid provider of CSCT.  The commenters also asked the department for clarification regarding who submits the billing.

RESPONSE #12:  The requirements set forth in New Rule III (ARM 37.87.1803) currently exist in ARM 37.86.2225.  ARM 37.86.2225 is being repealed as part of this rule making and relocated into the children's mental health bureau's rule chapter.  The department will amend the proposed rule to better reflect reimbursement requirements for the CSCT program.  The school district is the provider but who submits the billing for services is left to contractual agreement.

COMMENT #13:  Many commenters asked the department to assure that the mental health center provided CSCT services is not responsible for cost recovery as a result of the provider failing to provide annual documentation to the department.

RESPONSE #13:  Since the school is the provider of CSCT services and the mental health center is the contractor, indemnification clauses would more properly be in contract than in administrative rule.  This request is outside the scope of this rule-making process.

COMMENT #14:  Many commenters asked the department to describe the required format and information required in New Rule III (ARM 37.87.1803) for the annual report regarding the effectiveness of the CSCT program.  The same commenters also asked the department to amend the rule to require that the report reflect the mutual contributions of both entities for the contents of the report.  The commenters also requested the department clarify that "program referrals" mean CSCT referrals.

RESPONSE #14:   Since requiring a report on the effectiveness of the program is a new requirement, the department would like to avoid over-prescribing the contents in this first effort at evaluation, in hope that the leeway allowed will lead to some naturally strong examples that could then be shared in a statewide collaborative effort.  The department does see the benefit in requiring the mental health center and the school to work together on the report and will amend the proposed rule to require mutual contributions of both the school and the mental health center.  The proposed rule will also be amended to reflect that program referrals mean CSCT referrals.

COMMENT #15:  One commenter asked the department to be more prescriptive regarding the certification of match documents, noting the schools must provide both a copy of the match certification and a copy of the match worksheet to the Office of Public Instruction annually.  The commenter also asked the department to combine the requirements of New Rule III (ARM 37.87.1803) (7) and (8).

RESPONSE #15:  The department will amend the rule to state the documentation is required by the department and will provide details regarding the documentation in another venue.  The department appreciates the commenter's suggestion to combine New Rule III (ARM 37.87.1803) (7) and (8) but will leave them separate as this is the format preferred by the department.

COMMENT #16:   One commenter asked the department to limit the paperwork requirements for brief intervention, assessment, and referral services to ensure that the burden of documentation does not inhibit the use of this service.

RESPONSE #16:  Proposed changes to ARM 37.106.1961 require only a signed referral, progress notes, and a discharge plan for the youth.  The requirements do not impose an undue burden on providers.

COMMENT #17:  One commenter asked the department to amend the requirement for youth ages three to five, that in order to receive services, must attend a publically funded preschool and strike the requirement of an individualized education program (IEP).

RESPONSE #17:  The department agrees that it should be acceptable for a student, ages three to five, to receive CSCT services if the student attends a preschool program that is publicly funded.  The department will amend the proposed rule language to reflect this change.

COMMENT #18:  Many commenters asked whether the proposed rules included in MAR 37-619 for home support services (HSS) and therapeutic foster care will be included in the mental health center definitions as a service and whether or not HSS will require an endorsement.

RESPONSE #18:  The comment is outside the scope of this rulemaking process.

COMMENT #19:  Many commenters asked for clarification regarding the requirement that the child and adolescent needs and strengths (MT CANS) assessment be initiated within 14 calendar days of a referral.

RESPONSE #19:  There is merit in conducting the MT CANS with every referred youth to the CSCT program.  However, the department recognizes that requiring the MT CANS assessment on each referral at this point might place an undue burden on the CSCT staff just learning to use this assessment tool.  For this reason, the department will amend the proposed rule to require that the MT CANS assessment be initiated for each youth upon enrollment into the program.  In a further attempt to clarify, the department will also replace the term CANS with MT CANS.

COMMENT #20:  Several commenters asked the department to allow programs to consider other referrals in the absence of a signed or cosigned referral form.  The commenters also asked the department who cosigns a referral.  One commenter said the referral form is unnecessary.

RESPONSE #20:  The department believes that family choice is vitally important in the provision of mental health services.  A signed referral signifies that a legal representative is aware that a youth has been referred to the program.  The department will amend the proposed rule to state that each referral is to be signed by the person referring the student as well as the legal representative/guardian.

COMMENT #21:  Many commenters asked the department which entity is required or allowed to provide family therapy in the instance of a youth receiving concurrent CSCT and HSS.

RESPONSE #21:  Medicaid will not pay for duplicative services.  HSS and CSCT are both intended to be comprehensive services.  When a youth is receiving both services and the family identifies family therapy as a need, it must be received through the agency providing HSS services.

COMMENT #22:  Many commenters asked the department to retain the word "addictive" in ARM 37.106.1956(1)(f) and strike the term "chemical dependency."

RESPONSE #22:  The department deliberately chose chemical dependency as the term that describes the non-mental health addictive issues that may inflict youth.  However, in order to be consistent and up to date with nationally accepted terminology, the department will replace the term "chemical dependency" with "substance use disorders."  Other concerns youth may face fall under mental health.

COMMENT #23:  Several commenters asked the department to reconsider the requirement that four hours per week of CSCT services must be offered in summer months and during winter and fall break.  They also asked the department about the documentation requirements and consequences of not providing this service.

RESPONSE #23:  While breaks allotted by the schools are important, it is also important for youth who are actively working on a treatment plan to maintain momentum and have opportunity for therapeutic support.  The department will amend the proposed language to specify that the hours can be offered in any combination equal to 16 hours per month to assist with flexibility during summer break.  The department will remove the requirement during spring and winter breaks.  Maintaining a minimal amount of contact throughout the summer months also assists in youth transitioning back into school in the fall.

COMMENT #24:  Numerous commenters asked whether the department would require verification that the parent(s)/legal representative/guardian has been informed that Medicaid requires coordination of CSCT with HSS and outpatient therapy.

RESPONSE #24:  The department will amend the proposed language to reflect documentation requirements include a signed verification.

COMMENT #25:  Many commenters requested that the department amend the licensure requirements in ARM 37.106.1956(7)(b) regarding that the in-training mental health professional be licensed by the last day of the calendar year following the state fiscal year (July 1 through June 30) in which supervised hours were completed.

RESPONSE #25:  The commenter's suggestions focus on the application for licensure as opposed to receipt of a license.  This requirement is intended to address in-training practitioners not completing testing requirements rather than a failure to apply for licensure.  Having licensed practitioners adds to the value of the service.

COMMENT #26:  Many commenters requested that the department amend ARM 37.106.1956(8) to allow a high school diploma or a GED.

RESPONSE #26:  The department agrees with this request and will amend the proposed rule.

COMMENT #27:  A few commenters asked the department if, in ARM 37.106.1956(9)(c), the department is seeking information about referrals to the CSCT program.

RESPONSE #27:  The department will amend the proposed language to indicate this refers to the CSCT program.

COMMENT #28:  One commenter noted that the requirement for full time staff in ARM 37.106.1960(2) was eliminated when the staffing requirements were moved to ARM 37.106.1955.  The respondent asked if full time staff is still required.

RESPONSE #28:  The department will amend the proposed language in ARM 37.106.1956(7) and (8) to indicate that these positions must be full-time.

COMMENT #29:  Many commenters stated that many CSCT programs follow the policy of the school district in which they operate and do not physically restrain youth and asked about training regarding physical restraint.

RESPONSE #29:  The department understands that the CSCT program may follow the policy of the school district; however, the licensing requirements for a licensed mental health center involve de-escalation training inclusive of both physical and nonphysical methods.

COMMENT #30:  Many commenters asked for clarification regarding training on school culture in ARM 37.106.1960(f).

RESPONSE #30:  This will vary by individual school district and is left to the discretion of the provider.

COMMENT #31:  Many commenters asked if the department has identified or expects certain progress monitoring techniques in ARM 37.106.1960(3)(d).

RESPONSE #31:  The department is leaving specific training up to the provider or employer.

COMMENT #32:  Many commenters asked the department to decrease paperwork requirements for CSCT staff wherever possible; several suggestions were noted.

RESPONSE #32:  The department agrees with the commenter.  A recent federal audit suggests that a provider should total the entire amount of time spent for a day and bill once for the correct number of units.  The department will amend ARM 37.106.1961(1)(d) and (3)(b) to reflect daily progress notes.  Commenters may refer to the general Medicaid documentation requirements for additional documentation requirements.  This will eliminate the need for a separate note for every time a therapist or aide has contact with a youth.

COMMENT #33:  One commenter asked the department to develop a universal referral form.

RESPONSE #33:  While the department sees the potential value of a universal form, the inclusion should be discussed for future rulemaking as it is outside the scope of this rulemaking.

COMMENT #34:  Many commenters asked the department to consider using the term program therapist whenever the rules would allow the CSCT therapist, who is an in-training professional, to perform a function.

RESPONSE #34:  According to ARM 37.106.1902(24), a program therapist means a licensed mental health professional with the training and knowledge to provide psychotherapy.  The department will ensure that the rules specify in-training whenever the in-training licensed mental health professional could perform the function.

COMMENT #35:  One commenter stated disagreement with the department's fiscal impact statement because he believed the inclusion of intervention, assessment, and referral services would actually decrease the number of teams.

RESPONSE #35:  The department disagrees.  In cases where teams have a waiting list, the ability to provide 20 units of intervention, assessment, and referral services may actually increase the number of teams.

COMMENT #36:  Many commenters said they appreciate the inclusive, coordinated rulemaking process led by the department.  One commenter said she appreciated the coordinated effort by the provider coalition to respond to the rules.

RESPONSE #36:  The department appreciates the response of stakeholders to the coordinated rulemaking effort.

 

            6.  These rule amendments are effective July 1, 2013.

 

 

 

/s/ Kurt R. Moser                                           /s/ Richard H. Opper                        

Kurt R. Moser                                                Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services

           

Certified to the Secretary of State March 18, 2013