(1) The U.S. Department of Health and Human Services (HHS) has provided a grant to the Montana Department of Public Health and Human Services (department), under Section 6063 of the Deficit Reduction Act of 2005, that allows Montana to submit to the Centers for Medicare and Medicaid Services (CMS) a proposal to establish a program of Medicaid funded home and community-based services for youth who have serious emotional disturbance. That proposal has been presented to and approved by CMS. The purpose of this program is to avoid institutionalizing youth with serious emotional disturbance in residential treatment facilities. Institutionalization is avoided through the provision of mental health services and other services that support and treat those youth while residing with their families and receiving mental health treatment in the community.

(2) In accordance with the state and federal statutes and rules generally governing the provision of Medicaid funded home and community-based services and any federal-state agreements specifically governing the provision of the Medicaid funded home and community-based services to be delivered through this program, and within the fiscal limitations of the funding appropriated and available for the program, the department may determine within its discretion the following features of the program:

(a) the types of services to be available;

(b) the amount, scope, and duration of the services;

(c) the categories of youth to be served;

(d) the total number of service opportunities that may be made available;

(e) the total number of service opportunities that may be made available by category of eligibility or by geographical area;

(f) individual eligibility; and

(g) geographic service areas.

(3) A youth's enrollment in the program and the provision of services to the youth through the program are at the discretion of the department. There is no legal entitlement for a youth to enroll in the program or to receive any or all the services available through the program.

(4) The department has received federal approval to waive statewide coverage in the provision of program services. Program services may only be delivered in the following service areas for which federal approval of coverage has been received:

(a) Yellowstone County core site, implementation date of October 1, 2007.

(i) Service areas of Carbon, Stillwater, Musselshell, and Big Horn Counties added to the Yellowstone County core site, implementation date of October 1, 2010.

(b) Missoula and Ravalli Counties core site, implementation date of August 1, 2009.

(c) Cascade County core site, implementation date of October 1, 2010.

(d) Lewis and Clark County core site, with service areas of Jefferson and Broadwater Counties, implementation date of October 1, 2010.

(e) Flathead County core site, implementation date of July 1, 2011.

(5) In the service areas specified in (4) of this rule, no more than a total of 100 youth per waiver year for all core sites may be enrolled at any given time. A waiver year begins on October 1st and ends on September 30th.

(a) When a waiting list is established in any of the core sites, the protocol defined in the Psychiatric Residential Treatment Facility Home and Community Based Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 will be used by the department to reallocate unused service opportunities.

(6) The total cost of expenditures annually for services delivered through the program plus the total cost of Medicaid state plan costs for program participants annually may not exceed the total annual projected Medicaid cost for the participants if they were receiving treatment in a residential psychiatric treatment facility.