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| Montana Administrative Register Notice 37-648 | No. 18 09/19/2013 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On October 10, 2013, at 1:30 p.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 October 2, 2013, 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:
37.87.701 COMMUNITY-BASED PSYCHIATRIC REHABILITATION SUPPORT SERVICES (1) (2) CBPRS services (ii) remains the same, but is renumbered (a). (iv) and (v) remain the same, but are renumbered (c) and (d). (vii) remains the same, but is renumbered (f). (i) through (iii) remain the same, but are renumbered (a) through (c).
37.87.703 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), COVERED SERVICES (1) Mental health center services for youth with (a) Community- (b) Comprehensive school and community treatment in accordance with (c) through (e) remain the same. (f) Targeted case management (TCM) services as defined in ARM 37.87.802. (g) remains the same. (h) Home support services (HSS) and therapeutic foster care (TFC) as defined in ARM 37.87.1402(5).
AUTH: 53-2-201, 53-6-101, 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.733 MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), REIMBURSEMENT (1) Medicaid reimbursement for mental health center services shall be the lesser of: (a) remains the same. (b) the rate established in the department's Medicaid fee schedule, as adopted in ARM (2) For day treatment services, the department will not reimburse a mental health center provider for more than one fee per treatment day per youth. This does not apply to mental health professional services to the extent such services are separately billed in accordance with these rules or targeted case management services for youth with
AUTH: 53-2-201, 53-6-101, 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.809 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, REIMBURSEMENT (1) Targeted case management (TCM) services for youth with SED will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is a period of 15 minutes. (a) remains the same. (2) The department will pay providers of targeted case management services for youth with SED the lesser of: (a) remains the same. (b) the rate established in the department's Medicaid fee schedule, as adopted in ARM (3) (4) remains the same. (5)
IMP: 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
37.87.903 MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, AUTHORIZATION REQUIREMENTS (1) remains the same. (2) The department will not reimburse providers for two services that duplicate one another on the same day. (4) through (7) remain the same, but are renumbered (3) through (6). (9) and (10) remain the same, but are renumbered (8) and (9).
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113.htm" target="MCA">MCA
37.87.1013 THERAPEUTIC GROUP HOME (TGH), REIMBURSEMENT (1) The reimbursement rate for the therapeutic and rehabilitative portion of TGH or TGH with extraordinary needs aide (ENA) services is the lesser of (1)(a) or (b): (a) the amount specified in the department's Medicaid Mental Health Fee Schedule as adopted in ARM (b) through (7) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.1401 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 (b) through (4) remain the same.
37.87.1404 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 (2) through (5) remain the same.
37.87.1405 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), ASSESSMENTS (1) through (3) remain the same.
37.87.1407 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), PROVISIONS OF SERVICE (1) remains the same. (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 ARM (b) through (3) remain the same. (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) and (b) remain the same. (d) and (e) remain the same, but are renumbered (c) and (d).
37.87.1410 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), PROVIDER REQUIREMENTS (1) through (3) remain the same. (4) The clinical lead must: (a) remains the same. (c) through (e) remain the same, but are renumbered (b) through (d). (5) through (8) remain the same.
37.87.2233 MENTAL HEALTH SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED) RESPITE CARE SERVICES, PROVIDER REIMBURSEMENT (1) and (2) remain the same. (3) Reimbursement for respite care services is as provided in the department's Medicaid fee schedule, as adopted in ARM 37.85.105 (4) remains the same.
AUTH: 53-2-201, 53-6-101, 53-6-113, MCA IMP: 53-2-201, 53-6-101, 53-6-111, MCA
4. The department proposes to repeal the following rules:
37.87.1015 THERAPEUTIC GROUP HOME (TGH), AUTHORIZATION REQUIREMENTS is found on page 37-21354 of the Administrative Rules of Montana.
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.1017 THERAPEUTIC GROUP HOME (TGH), EXTRAORDINARY NEEDS AIDE (ENA) SERVICES, AND AUTHORIZATION REQUIREMENTS is found on page 37-21355 of the Administrative Rules of Montana.
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.1411 THERAPEUTIC FOSTER CARE PERMANENCY SERVICES, AUTHORIZATION REQUIREMENTS AND COVERED SERVICES is found on page 37-21421 of the Administrative Rules of Montana.
5. STATEMENT OF REASONABLE NECESSITY
In November 2012, the Children's Mental Health Bureau (CMHB) of the Department of Public Health and Human Services (department) filed a notice of public hearing on proposed adoption, amendment, and repeal in the matter of the adoption of New Rules I through X, the amendment of ARM 37.87.703, and the repeal of 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, 37.37.336, 37.87.1021, 37.87.1023, and 37.87.1025, pertaining to therapeutic family care and therapeutic foster care in MAR Notice No. 37-619. The proposed changes were intended to repeal multiple rules, reorganize, and propose new rules to provide clear guidelines of service expectations. Due to the response from stakeholders to that rulemaking proposal CMHB resolved to practice administrative discretion and postpone the implementation of those rules and continue to meet with stakeholders to address their concerns. These proposed rule amendments reflect the outcome from those meetings.
During the 63rd Montana Legislative Session, CMHB funding was decreased for the utilization review contract that is currently held by Magellan Medicaid Administration, Inc. As a result of this reduction in funding, the CMHB is removing the prior authorization requirements to the following services: Partial Hospital Programs (PHP); Therapeutic Foster Care permanency (TFOC-P); 1915i/PRTF Waiver services; and outpatient therapy concurrent with therapeutic group homes. These changes are reflected in the Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management.
Further proposed amendments clean up language which is redundant with the mental health center rules, update ARM references which have changed, and better organize CMHB rules.
ARM 37.87.701
The department is proposing to amend (3) to specify what services require community-based psychiatric rehabilitation support (CBPRS) services to be prior-authorized (PA) by the department or its designee. This is necessary to ensure the rule specifies the PA requirements and adds information regarding who to submit PA requests to. The department is also renumbering this rule in order to make it more readable.
ARM 37.87.703
The department is proposing to add home support services (HSS) and therapeutic foster care (TFC) to this rule. This is necessary because this rule provides a list of mental health center services for youth with serious emotional disturbances and home support services and therapeutic foster care are among those services provided by mental health centers. The department also proposes to update rule references in (1)(b) from ARM 37.86.2224 to ARM Title 37, chapter 87, subchapter 18. This is necessary to reflect the amendment to the comprehensive school and community treatment rules which was effective July 1, 2013.
ARM 37.87.733, 37.87.809, 37.87.1013, and 37.87.2233
The department proposes to update the reference to the Medicaid Youth Mental Health Services Fee Schedule, which is now adopted and incorporated into ARM 37.85.105(6). This is necessary because, effective July 1, 2013, the department consolidated fee schedules into one rule to provide an organized and streamlined process for updating fee schedules.
ARM 37.87.903
The department is proposing to remove the adoption and incorporation by reference of the Medicaid Mental Health Plan and Mental Health Services Plan for Youth Services Excluded from Simultaneous Reimbursement (service matrix), effective August 1, 2011, from (2). The service matrix has been updated and is proposed as an appendix to the Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management dated January 31, 2013 (manual). A copy of the proposed manual can be viewed under the Children's Mental Health heading at the department's web site: http://www.dphhs.mt.gov/publications/index.shtml#cmh.
The manual is also being updated to reflect the outcomes of the stakeholder meetings as stated above. In MAR Notice No. 37-619 the department had proposed to exclude HSS and TCM as concurrent services. As an alternative, the department is proposing to update and apply the clinical management guidelines and eligibility criteria for HSS and TCM as the instrument for determining the need for home support services and targeted case management in order to realize the goal of clinically appropriate service delivery while maintaining fiscal efficiency. The department is proposing an effective date of the manual of November 15, 2013 to align with the rule effective date.
The department is also removing the list of services in (3) which require prior authorization or continued authorization. The department determined that this information already exists in other areas of rule and therefore it is redundant to maintain this list. Prior authorization and continued authorization requirements have not changed.
ARM 37.87.1401
As stated above, in MAR Notice No. 37-619 the department had proposed to exclude HSS and TCM as concurrent services. As an alternative, the department is proposing to update and apply the clinical management guidelines and eligibility criteria for HSS and TCM as the instrument for determining the need for home support services and targeted case management in order to realize the goal of clinically appropriate service delivery while maintaining fiscal efficiency.
The department also proposes to correct the reference to the Medicaid Youth Mental Health Services Fee Schedule, which is now adopted and incorporated by reference in ARM 37.85.105(6). This is necessary because effective July 1, 2013, the department consolidated fee schedules into one rule to provide an organized and streamlined process for updating fee schedules.
ARM 37.87.1404
The department is proposing to remove the language from ARM 37.87.1404 which is superfluous in view of the fact that the mental health center rules include the requirements for an individualized treatment plan.
ARM 37.87.1405
The department is proposing to remove the functional assessment requirement from this rule. This is necessary to eliminate redundancy with the mental health center rules.
ARM 37.87.1407 and 37.87.1410
The department is proposing to remove the requirement for the clinical lead to provide therapy to the caregiver and the family. In the meetings held with stakeholders, they clearly articulated opposition to the addition of this requirement. The department agrees that HSS is a time-limited service intended to promote skills and provide training for the caregiver in support of the youth; therefore, family therapy may or may not be clinically appropriate. The removal of this requirement is necessary in order to promote clinically appropriate services to youth and their caregivers. The department is proposing to correct an error in this rule. ARM 37.87.1402 should be ARM 37.87.1404. This correction will provide a correct reference.
ARM 37.87.1015, 37.87.1017, and 37.87.1411
The department is proposing to repeal these rules due to changes in the prior authorization requirements for therapeutic group homes, extraordinary needs aide services provided in a therapeutic group home, and therapeutic foster care permanency. This is necessary due to the decrease in funding for utilization review which has resulted in a change to the authorization requirements. CMHB is proposing the amended authorization requirements in the Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management.
Fiscal Impact
The department estimates, given current conditions and assuming providers of the affected services do not change their current practices, the fiscal impact for the proposed removal of the prior authorization requirements for Partial Hospital Programs (PHP), Therapeutic Foster Care permanency (TFOC-P), 1915i/PRTF Waiver Services, and outpatient therapy concurrent with therapeutic group homes will increase expenditures by approximately $1 million per year or $2 million over the biennium. The proposed changes to home support services (HSS) are projected to reduce expenditures by $1,455,000 for the biennium.
6. The department intends to adopt these rule amendments effective November 15, 2013.
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., October 17, 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.
12. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly or directly impact small businesses.
/s/ John C. Koch /s/ Richard H. Opper John C. Koch Richard H. Opper, Director Rule Reviewer Public Health and Human Services
Certified to the Secretary of State September 9, 2013.
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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].
