BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.86.3006, 37.87.102, 37.87.903, 37.87.1013, and 37.87.1223, and the repeal of ARM 37.87.303 pertaining to the revision of the rules for serious emotional disturbance for youth, mental health outpatient partial hospital services, and Medicaid mental health authorization requirements

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT AND REPEAL

 

TO: All Concerned Persons

 

            1. On July 30, 2014, 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 and repeal 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 July 23, 2014, 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 rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.86.3006 MENTAL HEALTH OUTPATIENT PARTIAL HOSPITAL SERVICES, REQUIREMENTS (1) Medicaid reimbursement is not available for outpatient partial hospitalization services unless the provider submits to the department or its designee in accordance with these rules a complete and accurate Certificate of Need, certifying that:

            (a) the recipient person is experiencing psychiatric symptoms of sufficient severity to create severe impairments in educational, social, vocational, and/or interpersonal functioning;

            (b) the recipient person cannot be safely and appropriately treated or contained in a less restrictive level of care;

            (c) proper treatment of the beneficiary's person's psychiatric condition requires acute treatment services on an outpatient basis under the direction of a physician; and

            (d) the services can reasonably be expected to improve the recipient's person's condition or prevent further regression; and.

            (e) the recipient's has exhausted or cannot be safely and effectively treated by less restrictive alternative services, including day treatment services or a combination of day treatment and other services.

            (2)  Partial hospitalization services may include day, evening, night, and weekend treatment programs that must employ an integrated, comprehensive, and complementary schedule of recognized treatment or therapeutic activities.

            (a) (3)  Acute level partial hospitalization is provided by programs which:

            (i) (a)  are operated by a hospital as described defined in 50-5-101, MCA, and are collocated with that hospital such that in an emergency a patient of the acute partial hospitalization program can be transported to the hospital′s inpatient psychiatric unit within 15 minutes;

            (ii) (b)  serve primarily individuals persons being discharged from inpatient psychiatric treatment or inpatient psychiatric residential treatment; and

            (iii) (c)  provide psychotherapy services consisting of at least individual, family, and group sessions at a frequency designed to stabilize patients the person sufficiently to allow discharge to a less intensive level of care at the earliest appropriate opportunity, on average, after 15 or fewer treatment days.

            (b) (4) Acute level partial hospitalization is reimbursed according to ARM 37.86.3022.

            (c) Subacute level partial (SAP) hospitalization is provided by programs which:

            (i) operate under the license of a general hospital with a distinct psychiatric unit or an inpatient psychiatric hospital for individuals under 21;

            (ii) operate a self-contained facility and offer integrated mental health services appropriate to the individual′s needs as identified in an individualized treatment plan;

            (iii) provide psychotherapy services consisting of at least three group sessions per week and five individual and/or family sessions per month;

            (iv) encourage and support parent and family involvement;

            (v) provide services in a supervised environment by a well-integrated, multidisciplinary team of professionals which includes program therapists, behavioral specialists, teachers, and ancillary staff;

            (A) a program therapist must be a licensed mental health professional who is site-based;

            (B) a program therapist must have an active caseload that does not exceed ten program clients;

            (C) a behavioral specialist must be site-based and have a bachelor′s degree in a behavioral science field or commensurate experience working with children with serious emotional disturbance. There must be one behavioral specialist for each five youth in the SAP program; and

            (D) all staff responsible for implementing the treatment plan must have a minimum of 24 hours orientation training and 12 additional hours of continuing education each year relating to serious emotional disturbance in children and its treatment. Training must include specific instruction on recognizing the effects of medication.

            (vi) provide education services through one of the following:

            (A) full collaboration with a school district;

            (B) certified education staff within the program; or

            (C) interagency agreements with education agencies.

            (vii) provide crisis intervention and management, including response outside of the program setting;

            (viii) provide psychiatric evaluation, consultation, and medication management on a regular basis. Psychiatric consultation to the program treatment staff is provided at least twice each month and includes at least one face-to-face evaluation with each youth each month;

            (ix) serve children or youth with a serious emotional disturbance being discharged from inpatient psychiatric treatment or residential treatment or who would be admitted to such treatment in the absence of partial hospitalization; and

            (x) are designed to stabilize patients sufficiently to allow discharge to a less intensive level of care, on average, after 60 or fewer treatment days.

            (d) Subacute level partial hospitalization is reimbursed at the rate specified in the department′s Medicaid Mental Health Fee Schedule.

            (3) For recipients determined Medicaid eligible by the department as of the time of admission to the partial hospitalization program, the Certificate of Need required under (1) must be:

            (a) completed, signed and dated prior to, but no more than 30 days before, admission; and

            (b) made by a team of health care professionals that has competence in diagnosis and treatment of mental illness and that has knowledge of the recipient's situation, including the recipient's psychiatric condition. No more than one member of the team of health care professionals may be professionally or financially associated with a partial hospitalization program. The team must include:

            (i) a physician that has competence in diagnosis and treatment of mental illness, preferably in psychiatry;

            (ii) a licensed mental health professional; and

            (iii) an intensive case manager employed by a mental health center or other individual knowledgeable about local mental health services as designated by the department.

            (4) For recipients who are being transferred from a hospital's acute inpatient program to the same facility's partial hospitalization program, the certificate of need required under (1) may be completed by a facility based team of health care professionals:

            (a) that has competence in diagnosis and treatment of mental illness and that has knowledge of the recipient's psychiatric condition;

            (b) that includes a physician that has competence in diagnosis and treatment of mental illness, preferably in psychiatry, and a licensed mental health professional; and

            (c) the Certificate of Need must also be signed by an intensive case manager employed by a mental health center or other individual knowledgeable about local mental health services as designated by the department.

            (5) For recipients determined Medicaid eligible by the department after admission to or discharge from the facility, the Certificate of Need required under (1) is waived. A retrospective review to determine the medical necessity of the admission to the program and the treatment provided will be completed by the department or its designee at the request of the department, a provider, the individual, or the individual's parent or guardian. Request for retrospective review must be:

            (a) received within 14 days after the eligibility determination for recipients determined eligible following admission, but before discharge from the partial hospitalization program; or

            (b) received within 90 days after the eligibility determination for recipients determined eligible after discharge from the partial hospitalization program.

            (6) All Certificates of Need required under (1) must actually and personally be signed by each team member, except that signature stamps may be used if the team member actually and personally initials the document over the signature stamp.

            (5) Subacute partial hospitalization is provided for in ARM 37.87.903(8).

            (7) (6)  Prior authorization is not a guarantee of payment as Medicaid rules and regulations, client eligibility, or additional medical information on retrospective review may cause the department to refuse payment.

 

AUTH: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

 

            37.87.102 Mental Health SERVICES (MHS) for YOUTH with serious emotional disturbance (SED), Definitions As used in this chapter, the following terms apply:

            (1) remains the same.

            (2) "Applicant" means a youth with SED for whom the process to determine eligibility has been initiated but not completed.

            (3) "Correctional or detention facility" means:

            (a) the Pine Hills youth correctional facility;

            (b) the Riverside youth correctional facility;

            (c) a Department of Corrections boot camp;

            (d) a juvenile detention center;

            (e) a city or county criminal detention facility; or

            (f) any privately operated or out-of-state correctional or detention facility that the state of Montana may choose to utilize in place of one of the above facilities or categories of facilities.

            (4) "Emergency" means a serious medical or behavioral condition resulting from mental illness which arises unexpectedly and manifests symptoms of sufficient severity to require immediate care to avoid jeopardy to the life or health of the youth or harm to another person by the youth.

            (5) "Federal poverty level" or "FPL" means the poverty guidelines for the 48 contiguous states and the District of Columbia as published under the "Annual Update of the HHS Poverty Guidelines" in the Federal Register each year on or about February 15 and subsequent annual updates.

            (6) remains the same, but is renumbered (2).

            (7) remains the same, but is renumbered (3).

            (8) (4)  "Medically necessary service" for Medicaid and MHSP is defined as provided in ARM 37.82.102.

            (9) remains the same, but is renumbered (5).

            (10) "Mental Health Services Plan (MHSP)" for youth with SED, in accordance with ARM 37.87.102, 37.87.303, 37.87.1503, 37.87.1513, 37.87.1703, 37.87.1723, 37.87.1733, 37.87.1903, 37.87.1915, 37.87.2103, and 37.87.2203 is a defined set of services.

            (11) remains the same, but is renumbered (6).

            (12) (7)  "Provider" means a person or entity that has enrolled and entered into a provider agreement with the department in accordance with the requirements of ARM 37.85.401 through 37.85.513 to provide mental health services to youth with SED on Medicaid or the Mental Health Services Plan.

            (13) remains the same, but is renumbered (8).

            (14) (9)  "Serious Emotional Disturbance (SED)" criteria are defined in ARM 37.87.303 the Children's Mental Health Bureau, Medicaid Services Provider Manual as adopted and incorporated by reference in ARM 37.87.903.

            (15) remains the same, but is renumbered (10).

            (16) (11)  "Youth" means:,

            (a) for Medicaid services, a person 17 years of age and younger or a person who is up to 20 years of age and is enrolled in an accredited secondary school with the exception for PRTF services, a person 17 years of age or younger; or.

            (b) for MHSP, a person 17 years of age and younger that is not eligible for Medicaid or the Children's Health Insurance Plan (CHIP) and meets the financial eligibility for MHSP.

 

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

IMP:     53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA

 

            37.87.903 MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, SERIOUS EMOTIONAL DISTURBANCE AND AUTHORIZATION REQUIREMENTS 

            (1) The department will not reimburse providers for some Medicaid services unless the prior authorization and continued authorization requirements are met.

            (2) remains the same, but is renumbered (1).

            (3) (2)  Medicaid mental health services for youth requiring approval prior to treatment, prior authorization, or continued stay authorization will be reimbursed only if the following requirements are met:

            (a) the youth, defined in ARM 37.87.102, has been determined to have a serious emotional disturbance defined in ARM 37.87.303 the Children's Mental Health Bureau, Medicaid Services Provider Manual, which has been verified by the department or designee; or

            (b) the department or designee has determined on a case-by-case basis, that treatment is medically necessary for early intervention and prevention of a more serious emotional disturbance:.

            (i) prior to treatment, (prior authorization); and

            (ii) when required, (continued authorization).

            (4) (3)  Youth are not required to have a serious emotional disturbance to receive the following outpatient therapy services:

            (a) the first 24 sessions of individual, and/or family, or both outpatient therapies per state fiscal year. Group outpatient therapy is not included in the 24-session limit; and

            (b) remains the same.

            (5) (4)  The department may waive a requirement for prior authorization or continued authorization when the provider submits documentation that:

            (a) the provider submits documentation that:

            (i) remains the same, but is renumbered (a).

            (ii) (b)  a timely request for prior authorization or continued authorization was not possible because of a an equipment failure or malfunction of the department's or its designee's equipment that prevented the transmittal of the request at the required time and the provider submitted a subsequent authorization request within ten business days.

     (b) (5)  cComputing the time for any request provided for in this subchapter includes weekends and holidays. If a deadline falls on a weekend or holiday, the deadline is the next business day.

            (c) (6)  If the department finds exceptional circumstances that reasonably justify a provider's failure to timely request prior authorization or continued authorization, it may extend the deadline for meeting the requirement.

            (6) remains the same, but is renumbered (7).

            (7) (8)  Review of authorization requests and retrospective reviews by the department or its designee will be made with consideration of the department's clinical management guidelines. In addition to the requirements contained in rule, the department has developed and published a provider manual entitled Children's Mental Health Bureau, Medicaid Services Provider Manual, dated September 5, 2014, for the purpose of utilization management. The department adopts and incorporates by reference the Children's Mental Health Bureau's, Provider Manual and Clinical Guidelines for Utilization Management dated November 15, 2013 Medicaid Services Provider Manual, dated September 5, 2014. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 or at www.dphhs.mt.gov/mentalhealth/children/index.shtml www.dphhs.mt.gov/publications/index.shtml#cmh.

            (8) and (9) remain the same, but are renumbered (9) and (10).

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

            37.87.1013 THERAPEUTIC GROUP HOME (TGH), REIMBURSEMENT

            (1) For the purpose of this subchapter, the following definitions apply:

            (a) "Patient day" means a whole 24-hour period that a youth is present and receiving TGH services. Even though a youth may not be present for a whole 24-hour period, the day of admission is a patient day. The day of discharge is not a patient day.

            (b) "Therapeutic intervention" is defined in ARM 37.97.102(23).

            (c) "Therapy"  is defined in ARM 37.97.102(26).

            (1) remains the same, but is renumbered (2).

            (2) The therapeutic services provided by the lead clinical staff (LCS) and the program manager (PM) are "therapy" and "therapeutic intervention" services defined as:

            (a) "Therapy " means the provision of psychotherapy and rehabilitative services provided by the LCS acting within the scope of the professional's license or same services provided by an in-training mental health professional in a TGH. These services include a combination of supportive interactions, cognitive therapy, interactive psychotherapy, and behavior modification techniques which are used to induce therapeutic change for youth in TGH. (Interactive psychotherapy means using play equipment, physical devices, language interpreter, or other mechanisms of nonverbal communication.)

            (b) "Therapeutic intervention" means interventions provided by the LCS or the PM under the supervision of the LCS to provide youth with activities and opportunities to improve social, emotional, and/or behavioral skill development and reduce symptoms of the youth's serious emotional disturbance. Interventions include implementing behavior modification techniques and offering psycho-educational groups and activities. Interventions may be provided to the youth individually, in a group setting or with the youth and family.

            (3) The purpose of the therapeutic services in (2) (1) is:

            (a) to reduce the impairment of the youth's mental disability of the youth and to improve the youth's functional level of the youth;

            (b) through (4) remain the same.

            (a) "Patient day" means a whole 24-hour period that a youth is present and receiving TGH services. Even though a youth may not be present for a whole 24-hour period, the day of admission is a patient day. The day of discharge is not a patient day.

            (5) and (6) remain the same.

            (7) Reimbursement will be made to a provider for reserving a TGH bed while the youth is temporarily absent for a THV for a maximum of 14 patient days per state fiscal year; requests for additional days must be prior authorized by the department. A THV is an opportunity to assess the youth's ability to successfully transition to a less restrictive level of care. For reimbursement the following criteria must be met:

            (a) the youth's treatment plan must document the medical need for a THV as part of a therapeutic plan to transition the youth to a less restrictive level of care;

            (b) the TGH provider clearly documents staff contact and youth achievements or regressions during and following the THV; and

            (c) the youth is absent from the provider's facility for no more than three patient days per THV, with a maximum of 14 THV patient days per state fiscal year, unless additional days are prior-authorized by the department.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

            37.87.1223 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, REIMBURSEMENT (1) For inpatient psychiatric services provided in a PRTF on or after December 31, 2013, for youth as defined in ARM 37.87.102, the Montana Medicaid Program will pay a PRTF for each patient day as provided in these rules. The Montana Medicaid Program will reimburse providers of inpatient psychiatric services provided to a youth in a PRTF for each patient day as provided in these rules, effective December 31, 2013.

            (a) remains the same, but is renumbered (2).

            (2) (3)  For in-state PRTFs, the Montana Medicaid Program will pay a provider, for each Medicaid patient day, a the following bundled per diem rate as specified in (3), less any third party or other payments. Services included in the bundled per diem rate are defined in (5).

            (3) The bundled per diem rate for in-state PRTF services is the lesser of:

            (a) and (b) remain the same.

            (4) Out-of-state PRTFs will be reimbursed 50% of their usual and customary charges. Services that must be included in the out-of-state PRTFs usual and customary rate are outlined in (7).

            (5) remains the same, but is renumbered (4).

            (6) (5)  The bundled per diem rate for in-state PRTFs does not include the following services, which listed in (a) through (d). are separately reimbursable by the Medicaid program for enrolled providers The Montana Medicaid Program will reimburse enrolled providers directly for the following services:

            (a) through (c) remain the same.

            (d) Medicaid state plan ancillary services as directed by the PRTF physician, except targeted case management provided by either the PRTF or by outside providers, if they are:. Medicaid state plan ancillary services must be stated in the plan of care of the youth.

            (i) in the plan of care for the youth;

            (ii) provided under the direction of the PRTF physician; and

            (iii) provided under an arrangement with other qualified providers.

            (6) Out-of-state PRTFs will be reimbursed 50% of their usual and customary charges. Services that must be included in the out-of-state PRTFs usual and customary rate are outlined in (7).

            (7) remains the same.

            (8) The bundled per diem rate for out-of-state PRTFs does not include the following services, which are separately reimbursable by the Medicaid program for enrolled providers listed in (a) through (c). The Montana Medicaid Program will reimburse enrolled providers directly for the following services:

            (a) and (b) remain the same.

            (c) Medicaid state plan ancillary services, as directed by the PRTF physician, provided by the PRTF or by outside providers, if they are: , enrolled as Montana Medicaid providers.  Medicaid state plan ancillary services must be stated in the plan of care of the youth.

            (i) in the plan of care for the youth;

            (ii) provided under the direction of the PRTF physician; and

            (iii) provided under an arrangement with other qualified providers.

            (9) The in-state and out-of-state PRTFs must maintain the medical records for Medicaid state plan ancillary services the youth receives.

            (10) Reimbursement will be made to in-state and out-of-state PRTF providers for reserving a bed while the youth is temporarily absent for a therapeutic home visit if:

            (a) the plan of care for the youth documents the medical need for therapeutic home visits as part of a therapeutic plan to transition the youth to a less restrictive level of care;

            (b) the provider clearly documents staff contact and youth achievements or regressions during and following the therapeutic home visit;

            (c) the youth is absent from the provider's facility for no more than three patient days per therapeutic home visit, unless additional days are authorized by the department; and

            (d) the out-of-state PRTF pays for transportation for youth on a therapeutic home visit from an out-of-state PRTF.

            (11) No more than 14 patient days per youth in each state fiscal year will be reimbursed for therapeutic home visits.

            (12) and (13) remain the same, but are renumbered (10) and (11).

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

4. The department proposes to repeal the following rule:

 

            37.87.303 YOUTH MENTAL HEALTH SERVICES, SERIOUS EMOTIONAL DISTURBANCE CRITERIA is found on page 37-21329 of the Administrative Rules of Montana.

           

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

IMP:     53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA

 

            5. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing to amend 37.86.3006, 37.87.102, 37.87.903, 37.87.1013, and 37.87.1223, and the repeal of ARM 37.87.303 pertaining to the revision of the rules for serious emotional disturbance for youth, mental health outpatient partial hospital services, and Medicaid mental health authorization requirements.

 

ARM 37.86.3006

 

The department proposes to amend ARM 37.86.3006 to remove the requirement for the Certificate of Need (CON) for partial hospital services. During the 63rd Montana Legislative Session, CMHB funding was decreased for the utilization review contract that is currently held by Magellan Medicaid Administration, Inc. As a result of this decrease in funding, the CMHB proposed a rule change on September 9, 2013 in MAR 37-648 which removed the requirement to submit the CON; rather, it was required the CON be placed in the file of the youth. That rule became effective November 15, 2013. The department has identified that the amendment to that rule conflicts with the CON requirements stated in ARM 37.86.3006. Due to the fact that a CON is not federally required for partial hospital services and that the function of the utilization contractor is no longer available for this service with CMHB, it is necessary to remove this requirement to maintain consistency within the Administrative Rules of Montana. Further amendments proposed to this rule serve to align current terminology and to clarify the rule, but do not substantively change the rule.

 

ARM 37.87.102

 

The department proposes to amend ARM 37.87.102 to remove reference to the Mental Health Services Plan (MHSP) for youth with Serious Emotional Disturbance (SED). This proposed amendment is necessary because the MHSP for youth with SED is no longer a service offered through the Children's Mental Health Bureau. The department also proposes to amend the reference for SED criteria from ARM 37.87.303 to 37.87.903. This is necessary because the department is proposing to remove the SED criteria from ARM 37.87.303 and place it into the "Children's Mental Health Bureau Medicaid Services Provider Manual" which is proposed to be adopted and incorporated into ARM 37.87.903 as part of this rule making.  The department is proposing to strike certain definitions from this rule which is necessary as those terms are no longer used within the CMHB's rules chapter. Further amendments proposed to this rule serve to align current terminology and to clarify the rule, but do not substantively change the rule.

 

ARM 37.87.903

 

The department proposes to amend ARM 37.87.903 to remove the "Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management dated November 15, 2013" and replace this manual with a new provider manual the Children's Mental Health Bureau (CMHB) developed. The previous manual provided by the CMHB titled, "Children's Mental Health Bureau Provider Manual and Clinical Guidelines for Utilization Management," dated November 15, 2013 presented providers enrolled in Montana Medicaid detailed instructions for initiating the review and appeals process and guidance regarding clinical guidelines for medical necessity. This is necessary because of feedback from providers the bureau received regarding the difficulty in navigating and understanding that document. The bureau determined it would be pragmatic to create a new manual that was more comprehensive and easier to navigate. As such, this proposed manual titled, "Children's Mental Health Bureau Medicaid Services Provider Manual" (manual), dated September 5, 2014 will supersede the previous CMHB Provider Manual and Clinical Guidelines for Utilization Management.

The majority of the information provided in the proposed manual remains the same as in its predecessor and has been simply reformatted; however, there are changes that are important to note:

 

(a) The serious emotional disturbance (SED) definition, diagnostic codes, and criteria have been moved from ARM 37.87.303 and are now in the manual.

 

(b) The Montana Child and Adolescent Needs and Strength (CANS-MT) functional assessment requirements have been added.

 

(c) The medical necessity criteria for acute hospital services have been rewritten to make them more direct and abbreviated.

 

(d) In response to a collaborative effort between CMHB and Therapeutic Group Home (TGH) providers, the admission criteria for TGH services has been modified into more applicable medical necessity criteria and the utilization process has been streamlined.

 

(e) The certificate of need requirement has been removed from Partial Hospital Program and Therapeutic Foster Care - Permanency services because this is not in line with the federal requirements for these services. The certificate of need medical necessity requirements must still be met for Therapeutic Foster Care - Permanency though a CON does not need to be completed.

 

(f) Clearer discharge requirements and criteria for the coordination of concurrent services are provided.

 

(g) The appeals process has been amended due to the changes with the Magellan Medicaid Administration contract.

 

Acute Hospital and Psychiatric Residential Treatment services will continue to have the utilization and appeals processes handled by Magellan.

 

Children's Mental Health Bureau will be managing the utilization process for Home Support Services, Therapeutic Foster Care, and Therapeutic Group Home Services.

 

The remaining CMHB services will follow their normal utilization and appeals processes.

 

ARM 37.87.1013

 

The department proposes to amend ARM 37.87.1013 to allow for 14 days of therapeutic home visits (THV) per youth per state fiscal year without the requirement to have prior authorization from the department for each THV that is longer than three patient bed days per visit and to remove the option for additional days.  This is necessary to allow providers more discretion over how the allowed 14 days is utilized. The department also proposes to remove the other service requirements for THV from this rule because the requirements are now in the proposed manual titled, "Children's Mental Health Bureau Medicaid Services Provider Manual" (manual), dated September 5, 2014, in ARM 37.87.903. Further amendments proposed to this rule serve to align current terminology and to clarify the rule, but do not substantively change the rule.

 

ARM 37.87.1223

 

The department proposes to amend ARM 37.87.1223 to remove the service requirements for THV from this rule because the requirements are now in the proposed manual titled, "Children's Mental Health Bureau Medicaid Services Provider Manual" (manual), dated September 5, 2014," in ARM 37.87.903. Further amendments proposed to this rule serve to align current terminology and to clarify the rule, but do not substantively change the rule.

 

ARM 37.87.303

 

The department is proposing to repeal ARM 37.87.303. This is necessary because the information previously contained in this rule is now located in the Children's Mental Health Bureau's new manual, "Children's Mental Health Bureau Medicaid Services Provider Manual."

 

Fiscal Impact:

 

Currently, after a child is in a therapeutic group home for 120 days, providers can make a continued stay request for an additional 120 days that is reviewed by the department's utilization review contractor Magellan. CMHB is proposing to have CMHB clinical staff complete the initial continued stay reviews after the first 120 days. If the clinical staff believes the continued stay request meets criteria for additional time at the group home, there will be a 90-day extension of service request option. If the department's clinical staff believes the continued stay request does not meet criteria for additional days, or the department's staff has questions about the appropriateness of the request, then the continued stay request will be forwarded to Magellan for review and decision.

 

This involvement of two reviewers for a limited number of cases could potentially increase the number of stays authorized when compared to current continued stays allowed. However, state clinical staff will follow specific guidelines on continued stay requests that should minimize any change in review procedures. Additionally, since the continued stay review will authorize 90 days instead of the current 120 days, there is a possibility that authorized days could actually decrease overall. It is anticipated that any fiscal impacts attributable to the change in continued stay reviews will be minimal.

 

            6. The department intends to adopt these rule amendments effective September 5, 2014.

 

            7. 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., August 7, 2014.

 

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

 

9. 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 7 above or may be made by completing a request form at any rules hearing held by the department.

 

10. 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.

 

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

 

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

 

 

 

 

 

/s/ John C. Koch                                          /s/ Richard H. Opper                                   

John C. Koch                                               Richard H. Opper, Director

Rule Reviewer                                               Public Health and Human Services

           

Certified to the Secretary of State June 30, 2014.