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| Montana Administrative Register Notice 37-534 | No. 5 03/10/2011 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF
TO: All Concerned Persons 1. On March 30, 2011 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 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 March 23, 2011 to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, Department of Public Health and Human Services, Office of Legal Affairs, 3. The rules as proposed to be adopted provide as follows: NEW RULE I DEVELOPMENTAL DISABILITIES COMMUNITY SERVICES ELIGIBILITY: TERMINATION OF ELIGIBILITY FOR A PROGRAM (1) Funding for all individuals receiving developmental disability community services as of February 28, 2011 funded by state general funds will terminate on July 1, 2011. (a) Individuals who apply for and are determined eligible for the Medicaid program will convert to Medicaid funded services. (2) The department may terminate a person's eligibility for a particular program of developmental disabilities services if the person, in accordance with this subchapter and the rules pertinent to eligibility for that program, does not meet the eligibility requirements for that program. The particular programs of developmental disability services are: (a) 37.34.207 Eligibility: Federally Funded Part H Family Education and Support Services; (b) 37.34.208 Eligibility: Federally Funded Intensive Family Education and Support Services; (c) 37.34.211 Eligibility: Children's Community Home Services; (d) 37.34.212 Eligibility: Children's Summer Day Services; (e) 37.34.217 Eligibility: Federally Funded Intensive Adult Services; and (f) 37.34.222 Eligibility: Federally Funded Senior Services. (3) The department may terminate a person's eligibility for a particular program of services for which the person no longer meets eligibility criteria if: (a) the program services or funding necessary to implement the person's service plan are unavailable from the program; (b) the professional and other services necessary to implement the person's service plan are unavailable; (c) the person does not cooperate in the eligibility determination process; (d) the person does not participate in the planning for service delivery; (e) the program services are no longer appropriate or cost effective in relation to the person's needs and there are no alternative program services available by which a service plan can be implemented to provide for the person's needs; (f) the person's failure to receive or participate in the program services poses imminent risk to the health and safety of the individual or another person; (g) behaviors of the person preclude the delivery of program services as provided for in the person's service plan; (h) behaviors of the person necessitate that the person must be served in a setting that is not available through the program or in which the services of the program may not be delivered; or (i) health status of the person necessitates that the person must be served in a setting that is not available through the program or in which the services of the program may not be delivered. AUTH: 53-20-204, MCA IMP: 53-20-203, 53-20-205, 53-20-209, MCA NEW RULE II DEVELOPMENTAL DISABILITIES COMMUNITY SERVICES ELIGIBILITY (1) For individuals who as of February 28, 2011 receive developmental disability community services and who are not Medicaid eligible, the department may, on or after July 1, 2011, convert funding for such services from state general funding to Title XX funding if such funding is available. (2) The department may apply available Title XX funding under this rule to maintain the eligibility of an individual and to prevent the termination of services by using the method set forth in the documents dated February 28, 2011 entitled "Application for Title XX Funding" and "Directions for Title XX Funding." The department hereby incorporates those documents by reference. The documents are available from the Developmental Disabilities Program, Department of Public Health and Human Services, (3) Individuals for whom neither Medicaid funding nor Title XX funding is available will be terminated from the developmental disability service program. AUTH: 53-20-204, MCA IMP: 53-20-203, 53-20-205, 53-20-209, MCA 4. The department proposes to repeal the following rules: 37.34.206 ELIGIBILITY: STATE FUNDED FAMILY EDUCATION AND SUPPORT SERVICES, is found on page 37-7253 of the Administrative Rules of Montana. AUTH: 53-20-204, MCA IMP: 53-20-203, 53-20-209, MCA 37.34.215 ELIGIBILITY: STATE FUNDED ADULT SERVICES, is found on page 37-7261 of the Administrative Rules of Montana. AUTH: 53-20-204, MCA IMP: 53-20-203, 53-20-209, MCA 37.34.216 ELIGIBILITY: STATE FUNDED ADULT INTENSIVE SERVICES, is found on page 37-7261 of the Administrative Rules of Montana. AUTH: 53-20-204, MCA IMP: 53-20-203, 53-20-209, MCA 37.34.221 ELIGIBILITY: STATE FUNDED SENIOR SERVICES, is found on page 37-7267 of the Administrative Rules of Montana. AUTH: 53-20-204, MCA IMP: 53-20-203, 53-20-209, MCA 5. REASONABLE NECESSITY: The Developmental Disabilities Program, Developmental Services Division, Department of Public Health and Human Services "the program" proposes converting services currently funded through the state general fund to Medicaid funding. This conversion process will result in savings to the state general fund of approximately 2.017 million dollars. The savings are necessary for the department to administer the program within budget limitations. The program has the option of using state general fund monies to fully fund services for individuals, and in the past has exercised this option for individuals who were ineligible to receive Medicaid or who were unwilling to apply for Medicaid. In the case of individuals who were not eligible for Medicaid funding, the department adopted rules identifying service categories for adult as well as children's services which could be funded with state general fund monies. However, the department has determined that it no longer can use state general fund monies to fund these services and meet its budget limitations. The department therefore proposes to repeal ARM 37.34.206, 37.34.215, 37.34.216, and 37.34.221. The repeal of these administrative rules will result in the termination of services in state-funded developmental disabilities programs. Individuals who are terminated from the services will have one of two options. Option one allows individuals who are Medicaid eligible to convert to Medicaid waiver funded services. Option two may allow the individual to continue to receive developmental disability services and is contingent on Title XX funding being available. Access to those services will be determined based on an application for Title XX funding. The department believes this is the best option to meet its budget limitations because it allows for the continued provision of services to most of the individuals who would be affected by this conversion to Medicaid funding. Where possible, the individuals' cost plans would be paid through the matching of state general fund monies to Medicaid monies allowing those individuals who can be converted to continue to receive needed services without interruption. At the same time, the state general fund liability is reduced by the amount of the matching funds. The department has considered other options, including the elimination of other programs and services but has determined that those options would impose significant hardship. This option makes available Medicaid funded services for individuals who apply for and become Medicaid eligible, and for those not eligible for Medicaid a prioritized selection process for continuing services depending on available funding. This rule is the culmination of an ongoing process. The process of converting individuals from general fund developmental disability programs to Medicaid is not new. In the past, the department has reviewed all available information and has converted to Medicaid funding large groups of individuals determined to be Medicaid eligible, and thereby realized significant savings to the state general fund liability, while continuing to provide services to those individuals without interruption. New Rule I
This rule proposes to terminate developmental disability community services effective July 1, 2011 for individuals receiving those services as of February 28, 2011 if they are funded by state general funding in order to meet budget limitations. Services for individuals terminated pursuant to this policy may convert to Medicaid funding if, and only if, they apply for and are determined to be eligible for Medicaid. By this rule the department also proposes to terminate services to individuals who, while initially determined to be eligible for developmental disabilities services, no longer meet the eligibility requirements. The rule describes the circumstances in which such individuals may become ineligible for and subject to termination of services by the department. This rule is necessary because the department will be providing services that are fully funded through Medicaid monies. Medicaid requires that all persons receiving services paid for by Medicaid must be and remain eligible for that program, and requires the department to repay any Medicaid funds expended on behalf of ineligible individuals. The department must have the authority to terminate services for any individuals who fail to meet or fail to continue to comply with Medicaid eligibility requirements in order to avoid having to repay Medicaid for funds expended on behalf of ineligible individuals. The department anticipates this change will result in a net decrease in state general fund spending of 2.017 million dollars per year in this program which services 350 persons. The department estimates that 25-30 persons would not be eligible for Medicaid or Title XX funding under this change. New Rule II By this rule the department proposes to convert the funding source of an individual not eligible for Medicaid from state general funding to Title XX funding, if available, while the individual is receiving services. In this particular phase of fund conversion, a person's fund will be converted from state general fund to Title XX if such funding is available. The rule will assist both the department and the individual by helping prevent the loss of services if Title XX funding is available. The rule is also necessary to allow the department to apply available Title XX funding to assist the individuals in maintaining eligibility and preventing termination of services, if possible. Some individuals currently in services will not be eligible for Medicaid but will still need services to remain in a community setting. Services for Title XX funded applicants are dependent upon availability of funding, and the department retains the authority to approve funding allocations for all Title XX funded applicants and service recipients. To ensure the department administers its program within budget limitations, the rule proposes to terminate services for individuals when Title XX funding is not available and those individuals are not Medicaid eligible. Referenced in and incorporated by this new rule are two documents entitled "The Application for Title XX Funding" and "Directions for Title XX Funding" which have been developed to aid in the selection of those individuals who will be eligible to use Title XX funds if such funds are available and if the department approves funding allocations for Title XX applicants and service recipients. Copies of these documents are available from the Developmental Disabilities Program, Department of Public Health and Human Services,
The department anticipates this change will result in a net decrease in state general fund spending of 2.017 million dollars per year in this program which services 350 persons. The department estimates that 25-30 persons would not be eligible for Medicaid or Title XX funding under this change.
ARM 37.34.206 The department proposes to repeal this rule by which a child may be eligible for state-funded family education and support services because all family services will be funded with federal, Title XX, or Medicaid funds.
ARM 37.34.215 The department proposes to repeal this rule by which an individual may be eligible for state-funded adult services because all adult services will be funded with federal, Title XX, or Medicaid funds. ARM 37.34.216 The department proposes to repeal this rule by which an individual may be eligible for state-funded adult services because all adult services will be funded with federal, Title XX, or Medicaid funds. ARM 37.34.221 The department proposes to repeal this rule by which an individual may be eligible for state-funded senior services because all senior services will be funded with federal, Title XX, or Medicaid funds. 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: Gwen Knight, 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., April 18, 2011. 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/ Francis X. Clinch /s/ Anna Whiting Sorrell Rule Reviewer Anna Whiting Sorrell, Director Public Health and Human Services Certified to the Secretary of State February 28, 2011
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A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact [email protected].
