Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the amendment of ARM 37.87.1202 and 37.87.1206 pertaining to Medicaid reimbursement for psychiatric residential treatment facility (PRTF) services

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

TO: All Concerned Persons

1. On May 6, 2010, at 10:00 a.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 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 April 27, 2010, to advise us of the nature of the accommodation that you need. Please contact Rhonda Lesofski, 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:

37.87.1202 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, DEFINITIONS As used in this subchapter, the following definitions apply:

(1) through (5) remain the same.

(6) "Psychiatric residential treatment facility (PRTF)" means a facility other than a hospital that provides psychiatric services only to individuals under age 21. The PRTF must be ~~licensed~~ certified for Medicaid participation by:

(a) the department as a PRTF; or

(b) the appropriate agency ~~as a PRTF or the equivalent~~ in the state where the facility is located as a PRTF.

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

IMP: 53-2-201, 53-6-101, 53-6-111, MCA

37.87.1206 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, PARTICIPATION REQUIREMENTS (1) remains the same.

(2) PRTF providers, as a condition of participation in the Montana Medicaid program, must comply with the following requirements:

(a) maintain a current license as a ~~PRTF~~ residential treatment facility under the rules of the department's Quality Assurance Division to provide PRTF services, or, if the provider's facility is not located within the state of Montana, maintain a current license in ~~the~~ an equivalent category under the laws of the state in which the facility is located;

(b) maintain a current PRTF certification for Montana Medicaid under the rules of the department's Quality Assurance Division to provide PRTF services or, if the provider's facility is not located within the state of Montana, meet the requirements of (2)(g) and (2)(h) Medicaid participation by the state in which the facility is located as required by the Centers for Medicare and Medicaid;

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

IMP: 53-2-201, 53-6-101, 53-6-111, MCA

4. The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.87.1202 and 37.87.1206 pertaining to Medicaid reimbursement for psychiatric residential treatment facility (PRTF) services. These proposed amendments are necessary to make it clear that out-of- state psychiatric residential treatment facilities (PRTFs) must be "certified" by the state survey agency in the state in which the facility is located to participate in the Montana Medicaid program, as required by the Centers for Medicare and Medicaid (CMS), the federal agency that oversees Medicaid.

The department is currently unable to authorize admissions to out-of-state PRTFs that are not currently "certified". This may create some access issues for youth requiring special treatment services not provided by the in-state and out-of-state PRTFs currently enrolled in Montana Medicaid who are certified.

As a result, some youths eligible for Montana Medicaid benefits might not receive needed mental health treatment or treatment might be delayed.

The department does not see an alternative to adding the certification requirement to the PRTF definition and participation requirements in rule. Department representatives confirmed the certification requirement in a recent meeting with CMS officials. Montana Medicaid's federal financial participation (FFP) would be jeopardized if the department did not require out-of-state PRTFs to be certified.

ARM 37.87.1202

The department is proposing an amendment to ARM 37.87.1201(6) "psychiatric residential treatment facility", that would require PRTFs to be certified in the state where the facility is located to participate in the Medicaid program, as required by CMS. The department is proposing to remove the requirement that a PRTF be licensed as this would duplicate the "participation requirement" in ARM 37.87.1206.

ARM 37.87.1206

The department is proposing an amendment to this rule pertaining to PRTF participation requirements, because in-state PRTFs are licensed as "residential treatment facilities", by the department. The department is proposing to add the certification requirement for out-of-state PRTFs so the requirement is the same for both in-state and out-of-state PRTFs.

Persons and entities affected

In state fiscal year 2009, for both in-state and out-of-state PRTFs, 431 youth received Medicaid services for a total expenditure of $12,975,766. It is anticipated that the in-state PRTFs or other out-of-state enrolled and certified PRTFs will be able to serve youth previously referred to the noncertified PRTFs. The department also anticipates some of the noncertified out-of-state PRTFs to become certified in the near future.

Fiscal effects

At this time, it is unknown what the fiscal impact will be with regard to holding admissions to out-of state noncertified PRTFs enrolled in Montana Medicaid.

5. The department intends to apply these rules retroactively effective February 1, 2010. A retroactive application of the proposed rules does not result in a negative impact to any affected party.

6. 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: Rhonda Lesofski, 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., May 13, 2010.

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

8. 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 6 above or may be made by completing a request form at any rules hearing held by the department.

9. 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.

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

/s/ John Koch /s/ Anna Whiting Sorrell

Rule Reviewer Anna Whiting Sorrell, Director

Public Health and Human Services

Certified to the Secretary of State April 5, 2010.