BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the adoption of NEW RULE I; the amendment of ARM 37.87.1201, 37.87.1202, 37.87.1203, 37.87.1206, 37.87.1207, 37.87.1215, 37.87.1216, 37.87.1217, and 37.87.1223; and the repeal of ARM 37.87.1210 and 37.87.1214, pertaining to provider participation, program requirements, and reimbursement procedures for psychiatric residential treatment facility (PRTF) services

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION, AMENDMENT, AND REPEAL

 

TO: All Concerned Persons

 

          1. On August 19, 2015, at 9:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, at Helena, Montana, to consider the proposed adoption, 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 the Department of Public Health and Human Services no later than 5:00 p.m. on August 12, 2015, 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 dphhslegal@mt.gov.

 

3. The rule as proposed to be adopted provides as follows:

 

NEW RULE I OUT-OF-STATE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, REIMBURSEMENT (1) Out-of-state psychiatric residential treatment facility (PRTF) services will be reimbursed at 50% of their usual and customary charges.

(2) The bundled per diem rate for out-of-state PRTFs services coverage includes the following services:

(a) all services, therapies, and items related to treating the condition of the youth;

(b) all services provided by licensed physicians, psychiatrists, midlevel practitioners, psychologists, clinical social workers, and professional counselors;

(c) psychological testing;

(d) lab and pharmacy services; and

(e) supportive services necessary for daily living and safety.

(3) The Montana Medicaid Program will reimburse enrolled providers directly for the following services which are not included in the out-of-state per diem rate:

(a) up to 80 units of targeted case management services, as defined in ARM 37.86.3301, per PRTF stay; and

(b) a clinical intake assessment by a licensed mental health center, with an endorsement to provide adult services for transition age youth 17 to 18, to determine whether they have a severe and disabling mental illness and if they qualify for adult mental health services.

(4) The Montana Medicaid Program will reimburse state plan ancillary services in addition to the out-of-state bundled per diem rate when these ancillary services are provided by a different provider under arrangement with the PRTF. The ancillary services provided must be:

(a) directed by the PRTF physician;

(b) stated in the treatment plan of the youth; and

(c) documented in the medical records for the youth.

 

AUTH:  53-6-101, MCA

IMP:     53-6-113, MCA

 

4. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

          37.87.1201 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, PURPOSE (1) The purpose of ARM 37.87.1201, 37.87.1202, 37.87.1203, 37.87.1206, 37.87.1207, 37.87.1214, 37.87.1215, 37.87.1216, 37.87.1217, 37.87.1222, 37.87.1223, 37.87.1224, 37.87.1225, and 37.87.1210 ARM Title 37, chapter 87, subchapter 12 is to specify provider participation and program requirements and to define the basis and procedure the department will use to pay for psychiatric residential treatment facility (PRTF) services.

          (2) remains the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

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

          (1) through (3) remain the same.

          (4) "Inpatient psychiatric services" means psychiatric residential treatment facility services, or hospital-based psychiatric residential treatment facility services.

          (5) remains the same.

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

          (a) the department as a PRTF; or

          (b) the appropriate agency in the state where the facility is located as a PRTF is defined in the Children's Mental Health Bureau Medical Services Provider Manual, adopted and incorporated by reference in ARM 37.87.903.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          37.87.1203 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES (1) Inpatient psychiatric services are services that comply with the requirements of this subchapter and the applicable federal regulations and are provided in a psychiatric residential treatment facility (PRTF) that is devoted to the provision of inpatient psychiatric care for persons under the age of 21.

          (2) 42 CFR 440.160 and 441.150 through 441.156 (2008) Title 42 CFR, part 441, subpart D provide federal definitions and federal PRTF program requirements. and tThe department adopts and incorporates them by reference 42 CFR 440.160 (2010) and Title 42 CFR, part 441, subpart D (2010). A copy of the regulations may be obtained through the Department of Public Health and Human Services, Health Resources Developmental Services Division, 1400 Broadway 111 N. Sanders, P.O. Box 202951 4210, Helena, MT 59620-2905 4210. 

 

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) These requirements are in addition to those contained in rule generally applicable to Medicaid providers.

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

          (a) through (d) remain the same.

          (e) accept, as payment in full for all operating and property costs, the amounts paid in accordance with the reimbursement method set forth in this rule and ARM 37.87.1201, 37.87.1202, 37.87.1203, 37.87.1207, 37.87.1214, 37.87.1215, 37.87.1216, 37.87.1217, 37.87.1222, 37.87.1223, 37.87.1224, and 37.87.1225;

          (f) (e)  for providers maintaining patient trust accounts, ensure that any funds maintained in those accounts are used only for those purposes for which the youth, or legal guardian, or personal representative of the patient has given written authorization. A provider may not borrow funds from these accounts for any purpose;

          (g) (f)  maintain accreditation as a PRTF by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), Council on Accreditation (COA), or the Commission on Accreditation of Rehabilitation Facilities (CARF) or any other an organization designated by the Secretary of the United States Department of Health and Human Services as authorized to accredit PRTF for Medicaid participation;

          (h) (g)  submit to the department prior to receiving initial reimbursement payments and thereafter within 30 days after of receipt, all accreditation determinations, findings, reports, and related documents documentation issued by the accrediting organization to the provider;

          (i)  provide PRTF services according to the service requirements for individuals under age 21 specified in Title 42 CFR, part 441, subpart D (2008). The department adopts and incorporates by reference Title 42 CFR, part 441, subpart D.  A copy of these regulations may be obtained through the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951;

          (j) (h) agree to indemnify the department in the full amount of the state and federal shares of all Medicaid inpatient psychiatric services reimbursement paid to the facility during any period when federal financial participation is unavailable due to facility failure to meet the conditions of participation specified in these rules or due to other facility deficiencies or errors;.

          (k) complete periodic surveys requested by the department. At a minimum, a PRTF must provide the following information:

          (i) average length of stay;

          (ii) special treatment programs offered or facility's ability to treat co-occurring issues such as developmental disabilities, chemical dependency; medically fragile and sexual reactivity or offending issues;

          (iii) specialized staff or evidence-based practices used;

          (iv) special assessments used, such as psychosexual or forensic; and

          (v) frequency of seclusion and restraint.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          37.87.1207 HOSPITAL-BASED PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, REQUIREMENTS (1) A hospital-based psychiatric residential treatment facility (PRTF) must meet the following requirements:

          (a) through (f) remain the same.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          37.87.1215 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, ASSESSMENT SERVICES (1) Psychiatric residential treatment facility (PRTF) assessment services are provided by in-state PRTF facilities and must comply with the requirements of this subchapter and the applicable federal regulations for PRTF services.

          (2) PRTF assessment services:

          (a) and (b) remain the same.

          (c) are reimbursed 15% higher than the department's current Medicaid Mental Health and Mental Health Services Plan, Individuals Under 18 Years of Age Youth Mental Health Fee Schedule for PRTF sServices.

          (3) Assessment services include the following, as clinically indicated:

          (a) through (c) remain the same.

          (d) chemical dependency substance use disorder assessment; and

          (e) through (5) remain the same.

          (6) Assessment services must be provided by qualified staff or contractors operating within the scope of their practice.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          37.87.1216 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, BENEFIT LIMITS, CERTIFICATION OF NEED, UTILIZATION REVIEW AND INSPECTIONS OF CARE REQUIREMENTS (1) Prior to admission and as frequently as the department deems necessary, the department or its agents may evaluate the medical necessity and quality of services for each Medicaid client member.

          (a) In addition to the other requirements of these rules, the provider must provide to the department or its agent upon request any records related to services or items provided to a Medicaid client member.

          (b) and (2) remain the same.

          (3) Medicaid reimbursement for PRTF services is not available for youth 18 years of age and older A provider must submit a certificate of need as described in the Children's Mental Health Bureau Medicaid Services Manual, adopted and incorporated by reference in ARM 37.87.903.

          (4) Medicaid reimbursement is not available for PRTF services unless the provider submits to the department or its designee a complete and accurate certificate of need for services that complies with the requirements of 42 CFR, part 441, subpart D (2008) and these rules.

          (a) For youth determined Medicaid eligible by the department at the time of admission to the facility, the certificate of need must:

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

     (ii) be made by an independent team of health care professionals that has competence in diagnosis and treatment of mental illness and that has knowledge of the youth's situation, including the youth's psychiatric condition. The team must include a physician that has competence in diagnosis and treatment of mental illness, preferably in child psychiatry, and a licensed mental health professional. No more than one member of the team of health care professionals may be professionally or financially associated with a PRTF program.

          (b) For youth who are transferred between levels of inpatient psychiatric care within the same facility, the certificate of need may be completed by the facility-based team responsible for the plan of care within 14 days after admission provided that the:

          (i) admission has been prior authorized by the department or the department's designee.

          (c) For youth who apply for and become Medicaid eligible after admission to the facility, the certificate of need must be made by the facility-based team responsible for the plan of care as specified in 42 CFR, 441.156:

          (i) within 90 days of the eligibility determination and must cover any period before application for which claims are made; and

          (ii) services are determined medically necessary by the department or the department's designee.

          (d) All certificates of need must be actually and personally 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) remains the same, but is renumbered (4).

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          37.87.1217 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, TREATMENT REQUIREMENTS (1) PRTF services must include active treatment designed to achieve the discharge of the youth to a less restrictive level of care at the earliest possible time. Active treatment includes, but is not limited to, the following services provided regularly and as clinically indicated:

          (a) individual psychotherapy;

          (b) group psychotherapy; and

          (c) family therapy.

          (2) remains the same.

          (3) A PRTF must submit a request for an eligibility determination to the department's developmental disability program (DDP) for youth suspected of having a developmental disability if a request has not already been made for youth 8 to 18 years of age. An eligibility determination for adult services may be requested for youth 16 years or older.

          (a) the PRTF must complete and submit to the DDP a cover letter along with the psychological testing and assessments required by the DDP; and

          (b) the PRTF must complete and submit additional documentation, if requested by the DDP.

          (4) The PRTF must use the Montana children and adolescent needs and strengths (MT-CANS) functional assessment for youth on admission and prior to discharge to assist in the development of the plan of care and the discharge plan.

          (5) (3)  The PRTF plan of care treatment plan must be comprehensive and address all psychiatric, medical, educational, psychological, social, behavioral, and developmental treatment needs.

          (6) (4)  The plan of care treatment plan and discharge plan for the youth must be reviewed at least every 30 days at the multidisciplinary treatment team meeting, and more frequently if there is a significant change in the condition of the youth. The parent or legal representative of the youth must be invited to participate in these meetings, and given adequate notice to participate. Adequate notice means generally a week unless the condition of the youth dictates otherwise. At a minimum the following must be discussed, if applicable to the needs of the youth:

          (a) diagnosis or changes to diagnosis;

          (b) mental status or changes to mental status;

          (c) medication use, purpose, and any changes;

          (d) treatment goals of the youth, progress or lack of progress, and revisions to the treatment plan;

          (e) risk behaviors and the use of special treatment procedures;

          (f) co-occurring issues that impact treatment of the youth, such as developmental or cognitive delays, substance use disorder, and sexual reactivity or offending;

          (g) individual, group, and family therapy outcomes; and

          (h) readiness for discharge of the youth, specific services needed on discharge, and who will be making the appointments for discharge services.

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

          (8) In addition to the other requirements in this rule that pertain to discharge planning the following activities are required. The PRTF must:

          (a) identify the community to which the youth will discharge;

          (b) develop a discharge plan within 30 days of admission that identifies the youth and family's needed services and supports upon discharge:

          (i) the discharge plan must address psychiatric, medical, educational, psychological, social, behavioral, developmental, and chemical dependency treatment needs, as appropriate.

          (c) make appointments for needed services and supports upon discharge, no less than seven days before discharge; and

          (d) work with the parent or legal representative of the youth independently, or for out-of-state PRTFs, with a targeted case manager, in making agreed upon discharge plans and referrals for needed services.

          (e) provide targeted case management services according to the limitations in ARM 37.87.1223, as needed.

          (6)  The content of the treatment plan and discharge plan must meet all minimum state and federal requirements.

          (9) If appropriate arrangements for services upon discharge are not made as required in (6) the PRTF may be at risk of losing its enrollment in the Montana Medicaid program.

          (10) As part of the discharge planning requirements, PRTFs must ensure the youth has a seven-day supply of needed medication and a written prescription for medication to last through the first outpatient visit in the community with a prescribing provider. Prior to discharge, the PRTF must identify a prescribing provider in the community and schedule an outpatient visit. Documentation of the medication plan and arrangements for the outpatient visit must be included in the medical record for the youth. If medication has been used during the PRTF treatment of the youth, but is not needed upon discharge, the reason the medication is being discontinued must be documented in the medical record for the youth. 

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          37.87.1223 IN-STATE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, REIMBURSEMENT (1) The Montana Medicaid Program will reimburse providers of inpatient psychiatric services provided to a youth in a psychiatric residential treatment facility (PRTF) for each patient day, as provided in these rules, effective December 31, 2013 which is consistent with the definition of a PRTF and all other applicable requirements are met.

          (2) Medicaid payment is not allowable for treatment or services provided in a PRTF that are not consistent with the definition of PRTF in ARM 37.87.1202 and unless all other applicable requirements are met.

          (3) (2) For in-state PRTFs, tThe Montana Medicaid Program will pay a provider for each Medicaid patient day, the following bundled per diem rate less any third party or other payments. The bundled per diem rate for in-state PRTF services is the lesser of:

          (a) and (b) remain the same.

          (4) (3) The bundled per diem rate for in-state PRTFs coverage includes the following services:

          (a) a direct-care wage add-on through a contract with the department or in the bundled per diem rate, as applicable; effective July 1, 2013;

          (b) through (f) remain the same, but are renumbered (a) through (e).

          (4) A direct-care wage add-on is reimbursed in addition to the in-state per diem through a contract with the department or in the bundled per diem rate, as applicable.

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

          (a) services provided by a licensed physician, psychiatrist, and or midlevel practitioner services;

          (b) remains the same.

          (c) adult mental health center evaluations for transition age youth 17 to 18, to determine whether or not they qualify for adult mental health services and have a severe and disabling mental illness; and.

          (d) (6) The Montana Medicaid Program will reimburse state plan ancillary services as directed by the PRTF physician, except targeted case management provided by either the PRTF or by outside providers. Medicaid state plan ancillary services must be stated in the plan of care of the youth. in addition to the in-state PRTF bundled per diem rate when these ancillary services are provided by a PRTF or by a different provider under arrangement with the PRTF. The ancillary services provided must be:

          (a) directed by a PRTF physician;

          (b) stated in the treatment plan of the youth; and

          (c) maintained in the medical records for the youth.

          (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) The bundled per diem rate for out-of-state PRTFs coverage includes the following services:

          (a) all services, therapies, and items related to treating the condition of the youth;

          (b) licensed physician, psychiatrist, and midlevel practitioner, psychologist, clinical social worker, and professional counselor services;

          (c) psychological testing;

          (d) lab and pharmacy services; and

          (e) supportive services necessary for daily living and safety.

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

          (a) up to 80 units of targeted case management services as defined in ARM 37.87.802 per PRTF stay;

          (b) a clinical intake assessment by a licensed mental health center, with an endorsement to provide adult services, for transition age youth 17 to 18, to determine whether or not they have a severe and disabling mental illness and if they qualify for adult mental health services; and

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

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

          (10) Providers must bill for PRTF services using the revenue codes designated by the department.

          (11) Notice of the admission and discharge dates for the youth must be submitted to the department or its designee the day of admission or discharge. The department may impose a $100 charge against the facility for each instance where the department does not receive timely notification.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

5. The department proposes to repeal the following rules:

 

          37.87.1210 OUT-OF-STATE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICE REQUIREMENTS found on page 37-21371 of the Administrative Rules of Montana.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          37.87.1214 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, SUBSTANCE USE DISORDER ASSESSMENT AND TREATMENT found on page 37-21373 of the Administrative Rules of Montana.

 

AUTH: 53-2-201, 53-6-113, MCA

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

 

          6. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing to adopt NEW RULE I; amend ARM 37.87.1201, 37.87.1202, 37.87.1203, 37.87.1206, 37.87.1207, 37.87.1215, 37.87.1216, 37.87.1217, and 37.87.1223; and repeal 37.87.1210 and 37.87.1214. These rules specify psychiatric residential treatment facility (PRTF) services provider participation and program requirements and define procedures the department uses to pay providers for PRTF services under the Montana Medicaid Program.  The proposed rulemaking is the result of feedback received by the department from providers, the department's required periodic review of its administrative rules, and is a continuation of the Children's Mental Health Bureau's efforts to incorporate certain regulations, program policies, and procedures into the Children's Mental Health Bureau Medicaid Services Provider Manual (Manual), which is adopted and incorporated by reference in ARM 37.87.903.

 

NEW RULE I

 

The department proposes the adoption of NEW RULE I to specify reimbursement requirements for out-of-state PRTF providers. The department has determined through reviewing ARM Title 37, chapter 87, subchapter 12, that a new rule specific to provider reimbursements for of out-of-state PRTF provider services is necessary because current rule language is not specific enough for consistent application of the rules by the department to out-of-state versus in-state PRTFs. If the department does not adopt NEW RULE I, there may be confusion for affected out-of-state providers and inconsistent interpretation of reimbursement parameters by the department.

 

ARM 37.87.1201, 37.87.1202, 37.87.1203, 37.87.1206, 37.87.1207, 37.87.1215, 37.87.1216, 37.87.1217, and 37.87.1223

 

The department proposes to amend rule language in these rules to achieve greater language consistency between the rules within the rule subchapter as well as achieve greater consistency between these administrative rules and the Manual. Additionally, the proposed amendments will remove redundancies that currently exist within these rules. Specifically, the department proposes the following amendments:

 

ARM 37.87.1201

 

The department proposes to strike individual rule references adopted for the subchapter's purpose and alternatively identify subchapter 12 in its entirety. This "housekeeping" amendment is necessary because the department intends for the rule to state a purpose for the entire subchapter, not just select rules, and providing a concise reference is consistent with departmental goals for improved rule writing.

 

ARM 37.87.1202

 

The department proposes to amend the definition in (6) for PRTF and cite directly to the definition in the Manual.

 

ARM 37.87.1203

 

The department proposes updating its adoption by reference of 42 CFR 440.160 (2008), to the most current version of the regulations which were amended by the Centers for Medicare and Medicaid (CMS) in 2010. The department has deemed this change necessary to achieve consistency with the most current federal guidelines that govern PRTF services under Medicaid. The department further proposes adopting and incorporating by reference 42 CFR, part 441, subpart D (2010), in its entirety, instead of the specific regulations currently listed (42 CFR 441.150 through 156) because all of subpart D of the these regulations apply to PRTF services. Currently, the adoption and incorporation of portions of these federal regulations are located in ARM 37.87.1203 and ARM 37.87.1206. By amending the rule to adopt and incorporate by reference all pertinent federal regulations, the department consolidates its federal regulations references relating to PRTF services into one rule.  Lastly, the department proposes to amend this rule further by changing reference adoption language to be consistent with the provisions of ARM 1.2.210. The department has deemed this change necessary to be consistent with departmental goals for improved rule writing.

 

ARM 37.87.1206

 

The department proposes the amendment of several subsections to improve internal references and general rule language to reflect departmental goals towards clear and understandable rule writing. Based on the proposed changes in ARM 37.87.1203, the department proposes removing subsections (2)(e), (2)(i), and (2)(k) from this rule.  Subsection (2)(e) addresses the Montana Medicaid Program's requirement to accept payment in full, (2)(k) addresses provider compliance with periodic department requests for the completion of requested surveys, and (2)(i) adopts and incorporates certain federal regulations. The department contends the proposed amendments are necessary since ARM Title 37, chapter 85 addresses provider participation requirements for the Montana Medicaid Program and it is redundant to identify these specific requirements in (2)(e) and (2)(k). Further, ARM 37.87.1203 provides a better location for the referenced federal regulations than in (2)(k). The changes are also consistent with departmental goals for improved rule writing.

 

ARM 37.87.1207

 

The department proposes amending this rule to provide for the original reference of the words from which the acronym PRTF is derived:  Psychiatric Residential Treatment Facility. Currently, PRTF is used multiple times in this rule but lacks an original reference. The department has deemed it necessary to fully reference the term first where used in a rule that is consistent with the department's current style of rule writing.

 

ARM 37.87.1215

 

The department proposes to amend the term "chemical dependency" to "substance use disorder" and to update the title of the fee schedule in (1)(c) to the current title. These changes are necessary to achieve consistent language between the rule, Manual, and current terminology. The department also proposes to remove (6) as it is substantially redundant of (1).

 

As with the proposed amendment in ARM 37.87.1207, the department proposes amending this rule to provide for the original reference of the words from which the acronym PRTF is derived:  Psychiatric Residential Treatment Facility, which is consistent with the department's current style of rule writing.

 

ARM 37.87.1216

 

The department proposes to amend the term "client" to "member" throughout the rule. These proposed changes are necessary as a continuation of departmental efforts to use terminology throughout its manuals and rules that conforms with current usage in the federal Medicaid programs.

 

The department proposes to remove certificate of need requirements and add these identical requirements into the Manual, as well as adding a new (3) which directs providers to the Manual for certificate of need requirements. These changes are necessary to incorporate the certificate of need service requirements into the Manual. They respond to specific provider feedback for inclusion of the subject matter into the Manual.

 

ARM 37.87.1217

 

The department proposes to remove specific treatment plan content requirements, discharge plan requirements, and therapy requirements from this rule and incorporate them into the Manual, as well as proposing to remove the requirements for serving youth with Serious Emotional Disturbance and Developmental Disability from rule and incorporating them into the Manual. The department has determined these changes are necessary to incorporate the treatment plan content requirements, discharge plan requirements, and therapy requirements into the Manual. They respond to specific provider feedback for inclusion of the subject matter into the Manual.

 

The department proposes to change the term "plan of care" to "treatment plan."

 

The department further proposes the addition of new (7) to provide a compliance component to the rule that treatment plans and discharge plans must meet all state and federal regulations.

 

These proposed changes are necessary to achieve consistent language throughout the rule, as well as achieving consistency between the rule, the Manual, and current department terminology.

 

ARM 37.87.1223

 

The department proposes to remove December 31, 2013 subchapter rule references from (1) because referencing the date and other rules in the current manner is unnecessary and is not consistent with administrative rule writing. As with the proposed amendments in ARM 37.87.1207 and ARM 37.87.1215, the department proposes amending this rule to provide for the original reference of the words from which the acronym PRTF is derived:  Psychiatric Residential Treatment Facility, which is consistent with the department's current style of rule writing.

 

The department proposes to strike all language related to an out-of-state PRTF from this rule and adopt similar language as proposed in NEW RULE I. The department has determined through reviewing its PRTF rules that separating requirements for in-state and out-of-state provider is necessary to give the respective providers more specific reimbursement parameters than what is currently being provided in this rule. Additionally, as described above, changes would render this rule only applicable to an in-state PRTF, so the department proposes to add IN-STATE to the rule's title.

 

The department proposes that the language in (4), (5), and (6) be revised to reflect what is in the current Montana Medicaid Plan for reimbursement of ancillary services.

 

The department has determined through review of the rule that the proposed amendments are necessary to ensure consistency between Montana Medicaid Plan content and language in rule.

 

ARM 37.87.1210

 

The department proposes the repeal of ARM 37.87.1210, which defines service requirements for out-of-state PRTFs, because these requirements are proposed to be relocated into the Manual. The department has determined the incorporation of out-of-state PRTFs requirements into the Manual is appropriate given the purpose of the Manual.  This also addresses specific provider feedback for inclusion of the subject matter into the Manual.

 

ARM 37.87.1214

 

The department proposes the repeal of ARM 37.87.1214 which addresses substance use disorder assessment and treatment in a PRTF since substance use disorder assessment and treatment is not a service requirement of a PRTF.

 

FISCAL IMPACT

 

The department has determined that there is no fiscal impact from the adoption of NEW RULE I; the proposed amendments to ARM 37.87.1201, 37.87.1202, 37.87.1203, 37.87.1206, 37.87.1207, 37.87.1215, 37.87.1216, 37.87.1217, 37.87.1223; and the repeal of 37.87.1210 and 37.87.1214, as proposed.

 

          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 dphhslegal@mt.gov, and must be received no later than 5:00 p.m., August 27, 2015.

 

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 adoption, amendment, and repeal of the above-referenced rules will not significantly and directly impact small businesses.

 

 

/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 20, 2015.