BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.106.2202 pertaining to updating residential treatment facilities rules

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

            1. On March 1, 2018, 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 of the above-stated rule.

 

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 the Department of Public Health and Human Services no later than 5:00 p.m. on February 14, 2018, 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 rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:

 

            37.106.2202  RESIDENTIAL TREATMENT FACILITY: LICENSURE STANDARDS (1) A residential treatment facility must meet the requirements of the following:

            (a) Tthe standards for the following categories, contained in the Joint Commission on Accreditation of Health Care Organizations' 1993 Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/Developmental Disabilities Services 2017 Comprehensive Accreditation Manual for Behavioral Health Care:

            (i) administrative/clinical management, as specified under the following headings:

            (A) governance and management (GM);

            (B) professional staff organization (PO), with the exception of PO.2.5.8.1;

            (C) human resources management (HR);

            (D) planning and evaluation (PE);

            (E) quality assessment and improvement (QA);

            (F) utilization review (UR);

            (G) research (RS), if provided;

            (H) patient rights (PI);

            (I) clinical records management (CR);

            (ii) patient services, as specified under the following headings:

            (A) patient management (PM);

            (B) child and adolescent services (CA);

            (C) forensic services (FC), if provided;

            (D) special treatment procedures (SC), if provided;

            (iii) patient support services, as specified under the following headings:

            (A) nutrition services (NU);

            (B) emergency services (ER);

            (C) pharmacy services (PH), as specified for residential settings in Appendix A;

            (D) physical health services (PY);

            (E)  libraries and information networks (LI);

            (F) rehabilitation services (RH), as specified for residential settings in Appendix A;

            (iv) environmental management, as specified under the following headings:

            (A) plant, technology and safety management (PL), as specified for residential settings in Appendix A;

            (B) therapeutic environment (TH);

            (C) infection control (IC), with the exception of IC.2.2.1 and IC.2.2.2.2--IC.2.2.4.1; and

            (v) for facilities in existence or for which construction had commenced prior to February 11, 1994, the interim life safety measures contained in Appendix D.

            (b) The standards contained in Title 42 CFR, part 441, subpart D, as they exist on October 1, 1992.

      (i) Care, Treatment, and Services (CTS);

      (ii) Environment of Care (EC);

      (iii) Emergency Management (EM);

      (iv) Human Resource Management (HRM);

      (v) Infection, Prevention and Control (IC);

      (vi) Leadership (LD);

      (vii) Life Safety (LS);

      (viii) Medication Management (MM);

      (ix) National Patient Safety Goals (NPSG);

      (x) Performance Improvement (PI);

      (xi) Record of Care, Treatment, and Services (RC);

      (xii) Rights and Responsibility of the Individual (RI); and

      (xiii) Waived Testing (WT).

            (2) A residential treatment facility may not share direct care staff or provide joint activities or treatment in conjunction with another type of health care facility, even if both facilities are under the same management, unless the joint activity involves facilities under a single management and is a specific treatment program that is clinically appropriate for all of the children engaged in it (e.g., appropriate for patients of both a residential treatment facility and an inpatient acute psychiatric facility).

            (3) remains the same.

            (4) The department hereby adopts and incorporates by reference the 1993 Accreditation Manual for Mental Health, Chemical Dependency, and Mental Retardation/Developmental Disabilities Services, published by the Joint Commission on Accreditation of Healthcare Organizations, 2017 Comprehensive Accreditation Manual for Behavioral Health Care. which contains accreditation standards for facilities providing mental health services, and Title 42 of the Code of Federal Regulations (CFR), part 441, subpart D (effective October 1, 1992), which contains standards for provision of inpatient psychiat­ric services to individuals under age 21.  Copies of these standards are available from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT  59620-2953.

            (5) The department adopts and incorporates by reference Title 42 CFR 440.160 (2010) and Title 42 CFR, part 441, subpart D (2010).

            (6) The residential treatment facility must have 24-hour onsite nursing care by a registered nurse.

            (7) The youth must be evaluated by a physician within 24 hours of admission.

            (8) All legal representatives of the youth must be consulted and invited to participate in the development and review of the treatment plan. Valid reasons must be indicated if such a plan is not clinically appropriate or feasible.

            (9) A comprehensive discharge plan directly linked to the behaviors and symptoms that resulted in admission and estimated length of stay must be developed upon admission.

            (10) If the youth is a student with disabilities, an individualized education plan (IEP) must be in place that provides programs and services consistent with requirements under the Individuals with Disabilities Education Act (IDEA) and state special education requirements. If the youth is not a student with disabilities, educational services and programs must be designed to meet the educational needs of the youth.

 

AUTH:  50-5-103, MCA

IMP:  50-5-103, 50-5-201, MCA

 

            4. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services is proposing to amend ARM 37.106.2202 regarding residential treatment facilities.

 

The amendments to the rule update references and clarify current practice for all licensed residential treatment facilities.

 

It is necessary to amend the residential treatment facility licensure rules in order to adopt and incorporate the current updated Joint Commission on Accreditation of Health Care Organization standards from the 1993 Manual to the 2017 Comprehensive Accreditation Manual for Behavioral Health Care and current updated Code of Federal Regulations for residential care facilities providing psychiatric care as published in 1992 to the 2010 standards. 

 

The department proposes to revise the rule for residential treatment facilities programs to clarify requirements in licensure rule for medical staff that is on call at all times, require 24-hour nursing staff on site, and meet the education requirements of each youth. The proposed changes are necessary to ensure compliance with federal CFR requirements, remain consistent with state Medicaid requirements, and ensure all youth receive appropriate medical oversight to treat and manage the psychiatric treatment provided in a residential treatment facility to psychiatrically impaired individuals with persistent patterns of emotional, psychological, or behavioral dysfunction of such severity as to require 24-hour supervised care to adequately treat or remedy the condition. 

 

Fiscal Impact

 

This rulemaking has no fiscal impact.

 

            5. 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., March 9, 2018.

 

6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

7. 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 5 above or may be made by completing a request form at any rules hearing held by the department.

 

8. The bill sponsor contact requirements of 2-4-302, MCA do not apply.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.

 

10. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.

 

The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.

 

 

/s/ Flint Murfitt                                               /s/ Sheila Hogan                                         

Flint Murfitt, Attorney                                   Sheila Hogan, Director

Rule Reviewer                                             Public Health and Human Services

 

 

Certified to the Secretary of State January 30, 2018.