BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the adoption of New Rule I pertaining to Short-Term Voluntary Inpatient Mental Health Treatment

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NOTICE OF ADOPTION

 

TO: All Concerned Persons

 

1. On August 27, 2015, the Department of Public Health and Human Services published MAR Notice No. 37-723 pertaining to the public hearing on the proposed adoption of the above-stated rule at page 1245 of the 2015 Montana Administrative Register, Issue Number 16.

 

2. The department has adopted the following rule 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 (37.89.1025)  CONTRACTS FOR PAYMENT OF SHORT-TERM INPATIENT TREATMENT (1) through (4) remain as proposed.

          (5)  Each contract with an eligible provider must provide that reimbursement will be made for up to 14 contiguous days of inpatient care for each eligible patient,. The 14 day limit must be extended if voluntary treatment is continued pending a hearing scheduled pursuant to 53-21-1205(5), MCA. Reimbursement must be made in the order in which claims from all eligible providers are received by the department until the available funding has been exhausted. The department must notify each eligible provider who has entered into a contract under this rule in writing when 75 percent of the available funding has been exhausted.

          (6) The following rates will apply:

          (a)  inpatient hospital behavioral health unit:  an all-inclusive rate of $875 per day, which includes hospitalization, professional fees, laboratory services, medications, minor medical procedures that do not require transfer to another unit of the hospital, evaluating and assessment services, discharge planning, and therapies.

          (b)  inpatient crisis stabilization program:  an all-inclusive rate of $575 per day, which includes crisis facility stay, professional fees, medical procedures, laboratory services related to psychiatric treatment, medications related to psychiatric treatment, evaluating and assessment services, case management, and therapies.

          (7) remains as proposed.

 

AUTH: 53-21-1202, MCA

IMP: 53-21-1202, 53-21-1205, MCA

 

3. 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: Four comments related to the inpatient crisis stabilization program all-inclusive rate. The comments stated concerns that the inclusion of medical procedures, lab, and pharmacy could possibly hold the facility liable for the expenses of those costs. The commenters recommended that the bundled rate only include those expenses related to psychiatric care and exclude medical procedures.

 

Response #1: The bundled rate does not include additional reimbursement for extraordinary medical procedures. The department has amended the rule to specify that the bundled rate does not include medical procedures, and includes laboratory services related to psychiatric care and medications related to psychiatric care. If a patient has a medical condition that requires transfer to another facility, this would constitute a discharge from short-term voluntary inpatient treatment at the inpatient crisis stabilization program.

 

During its consideration of this comment, regarding provider concern over potential liability for unreimbursed expenses, the department also took into account that the proposed rate did not fully reimburse the facility in the event that the commitment court extends the period of voluntary treatment for an additional 5 days pending a commitment hearing, as provided in 53-21-1205(2) and (5), MCA. The department has amended the rule to correct the omission.

 

This rule provides reimbursement for specified expenses. It does not determine responsibility for expenses not reimbursed under the rule.

 

Comment #2: One comment related to individuals who come in with another payer source but due to DRG or insurance limits will not have coverage for the full term of the short-term voluntary stay. The commenter would like the department to clarify if the program will provide payment beyond the DRG or insurance limits.

 

Response #2: The DRG is intended for the course of the care for the episode of the illness. The entire stay is covered by the DRG. A third party, therefore, has a legal liability for the services provided, and reimbursement would not be available under this program. The department has determined no amendment to the proposed rule is necessary.  

 

Comment #3: One comment related to the hospital behavioral health unit all-inclusive rate. The commenter asked whether the all-inclusive rate includes medical procedures when the individual has a medical emergency and whether the inpatient hospital behavioral health unit would be expected to pay from the all-inclusive rate.

 

Response #3: The bundled rate does not include additional reimbursement for emergency medical expenses. The department has amended the rule to specify that the bundled rate includes minor medical procedures which do not require transfer to another unit in the hospital. If a patient has a medical condition that requires transfer to another facility or another unit of the same hospital, this would constitute a discharge from short-term voluntary inpatient treatment at the behavioral health unit.

 

During its consideration of this comment, regarding provider concern over potential liability for unreimbursed expenses, the department also took into account that the proposed rate did not fully reimburse the facility in the event that the commitment court extends the period of voluntary treatment for an additional 5 days pending a commitment hearing, as provided in 53-21-1205(2) and (5), MCA. The department has amended the rule to correct the omission.

 

This rule provides reimbursement for specified expenses. It does not determine responsibility for expenses not reimbursed under the rule.

 

Comment #4: A commenter said clarification was needed on what happens when the individual needs to go to an emergency detention bed.

 

Response #4: Emergency detention is not voluntary; therefore, this would constitute a discharge from short-term voluntary inpatient treatment. The department has determined no amendment to the proposed rule is necessary.

 

Comment #5: A commenter asked for clarification on how and when the providers will be notified the funds for the program are exhausted.

 

Response #5: The department will notify the providers in writing when 75% of the program funds have been authorized. Prior authorizations will be approved dependent on funding. The department has amended the rule to clarify this.

 

          4. The department intends to apply this rule retroactively to July 1, 2015. A retroactive application of the proposed rule does not result in a negative impact to any affected party.

 

 

/s/ Paulette Kohman                              /s/ Robert Runkel for Richard H. Opper 

Paulette Kohman, Attorney                     Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services

         

Certified to the Secretary of State October 5, 2015