BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.87.2203 pertaining to changes to the non-Medicaid services provider manual

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NOTICE OF AMENDMENT

 

           TO: All Concerned Persons

 

1. On June 9, 2017, the Department of Public Health and Human Services published MAR Notice No. 37-798 pertaining to the public hearing on the proposed amendment of the above-stated rule at page 776 of the 2017 Montana Administrative Register, Issue Number 11.

 

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

 

            37.87.2203 NON-MEDICAID SERVICES PROGRAM (1) and (2) remain as proposed.

            (3) The department adopts and incorporates by reference the CMHB's Non-Medicaid Services Program Provider Manual, dated August 5, 2017 October 14, 2017 (the Manual), which sets forth the requirements and limitations of the CMHB's Non-Medicaid Services Program.

            (4) remains as proposed.

 

AUTH:  53-2-201, 53-6-113, 53-21-703, MCA

IMP:  53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-701, 53-21-702, 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: Two commenters responded to the proposed change to reduce the family financial eligibility limit for non-Medicaid services to 275% of Federal Poverty Level for family size.

 

One commenter expressed disappointment seeing reduction in access to mental health services for low-income families with seriously emotionally disturbed children and commented that the proposed new family financial eligibility limit for non-Medicaid services seems a quick but not effective way to balance budgets.

 

The second commenter stated there will be children who will not get their necessary mental health support because their families will not attempt to admit their child to therapeutic group home services due to the cost of room and board.  The commenter hoped the department would reconsider the proposed change and opined that providers will see increased business losses in these treatment arrangements because some families will not pay their portion of treatment costs despite signing contracts and receiving monthly bills.

 

RESPONSE #1: The department regrets the need to lower the financial eligibility limit in order to provide access to non-Medicaid services funding for the entire state fiscal year.  A fixed amount of state general funds is allocated for these services.  When the funding is spent, no non-Medicaid services can be authorized for youth. Beginning February of state fiscal years (SFY) 2015 and 2016, the department instituted wait lists and a prioritization paradigm for requests for the remainder of the fiscal year.  In SFY 2017, CMHB was running out of these funds again by February. 

 

COMMENT #2: One commenter asked for clarification of the program goals that the proposed reduction of the family financial eligibility limit for non-Medicaid services would address.

 

RESPONSE #2: The department desires that non-Medicaid services funding would be available during the entire state fiscal year, without having to issue denials for lack of funds or to institute wait lists for possible funding.  The department will review whether the proposed change results in the intended outcome and will consider unintended consequences as well.

 

COMMENT #3: One commenter asked for a definition of the "new language" to help understand the reason behind the proposed changes related to room and board funding for Therapeutic Group Home (TGH) for youth with HMK/CHIP.  This commenter also questioned the need for third party involvement, which appears to add to the expense of running a program and requiring a longer waiting period for a child to be admitted to the TGH.  The commenter believes that as a licensed clinical therapist who receives referral information from licensed psychiatrists, licensed mental health facilities, licensed PRTFs, and licensed mental health workers, that referral based information should be enough to verify if the youth has met SED requirements.

 

RESPONSE #3: The current non-Medicaid Services Manual (Manual) includes the requirement that room and board requests have a prior authorization for TGH therapeutic services from HMK+/Medicaid or HMK/CHIP.  For the proposed Manual, the department included new language which clarifies that the TGH therapeutic services authorization for youth with HMK/CHIP is made by that program's third-party administrator for clinical review for medical necessity.  This is not a change of practice.  Additional language provides that HMK/CHIP extended mental health benefit status is not required for eligibility for room and board requests or other non-Medicaid services requests.

    

/s/ Brenda K. Elias                                       /s/ Marie Matthews for                                

Brenda K. Elias                                            Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services

           

Certified to the Secretary of State October 2, 2017.