BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.87.903 pertaining to Children's Mental Health Bureau Medicaid Services Policy Manual Revisions
NOTICE OF AMENDMENT
TO: All Concerned Persons
1. On May 6, 2016, the Department of Public Health and Human Services published MAR Notice No. 37-751 pertaining to the public hearing on the proposed amendment of the above-stated rule at page 817 of the 2016 Montana Administrative Register, Issue Number 9.
2. The department has amended the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:
37.87.903 MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, AUTHORIZATION REQUIREMENTS (1) through (6) remain as proposed.
(7) 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 (Manual), dated
July 15, 2016 August 6, 2016, for the purpose of implementing requirements for utilization management. The department adopts and incorporates by reference the Children's Mental Health Bureau, Medicaid Services Provider Manual, dated July 15, 2016 August 6, 2016. 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 http://dphhs.mt.gov/dsd/CMB/Manuals.aspx.
(8) and (9) remain as proposed.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
3. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:
COMMENT #1: A commenter expressed gratitude for the opportunity to participate in the policy process. In addition, the commenter stated they are supportive of the discharge notification requirement and is open to the addition of a prior authorization requirement for Home Support Services (HSS) and advocated for the continued involvement of providers and families in the development of the utilization review process. The commenter also stated they support the removal of the five-day requirement for Home Support Services continued stay requests.
RESPONSE #1: The department appreciates the commenter's support and will continue to solicit feedback from providers and families in regards to the development of new policies pertaining to utilization review of Medicaid services.
COMMENT #2: One commenter expressed concerns with the addition of the diagnosis severity modifiers moderate or severe to Serious Emotionally Disturbed (SED) criteria and requested the state remove the language regarding severity modifiers. The commenter requests that providers and families are included in discussions regarding substantive changes to the SED criteria and that the department engage qualified professionals in the development of proposed changes.
RESPONSE #2: The severity modifiers of moderate to severe were not an addition to the criteria and there were no substantive changes to the SED criteria, the language was amended to clarify the criteria for youth under six as well as clarifying the annual requirement for reassessment. If the department were to amend the SED criteria, the department would utilize the three full-time licensed clinicians as well as a clinical supervisor on staff to assist with, and provide clinical insight into, the development of the utilization review process and the continued use of the serious emotional disturbance criteria. The department would then solicit feedback from additional qualified professionals and families prior to making substantive changes to the SED criteria.
COMMENT #3: One commenter requests that utilization review contractor staff be familiar with the youth receiving HSS and their families.
RESPONSE #3: The federal government, through the Centers for Medicare and Medicaid Services (CMS), requires all agencies serving a Medicaid population and receiving Medicaid funds to have a utilization management program in place to monitor the medical need for a service before payment for the intended service is authorized. The purpose of utilization review is to ensure that requested services are appropriate to address the mental health needs of the youth, as documented by the requestor, according to established clinical guidelines. Utilization review allows for a review from perspectives of medical necessity, quality of care, appropriateness, place of service, and length of stay based on the documented mental health needs of the youth. The utilization review process requires the reviewer to be unbiased, making determinations based solely on the documentation provided.
COMMENT #4: One commenter stated they believed the current behavioral criteria for determining SED status for youth under six is appropriate and that mental health diagnosis will often follow youth throughout their lifespan.
RESPONSE #4: It was not the intent of the department to amend the SED status criteria for youth under the age of six. The department has made language revisions in the manual based upon this comment in order to maintain the original intent of SED status for youth under the age of six. Due to this revision to the manual, the department is changing the effective date in ARM 37.87.903 to August 6, 2016.
/s/ Cary B. Lund /s/ Richard H. Opper
Cary B. Lund, Attorney Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State July 25, 2016