(1) The purpose of the developmental disabilities program is to provide quality community-based services in the least restrictive environment which promotes the principle of normalization for persons who are developmentally disabled.

For purposes of this chapter, the following definitions apply:

(1) "Abuse" means the infliction of physical or mental injury or the deprivation of food, shelter, clothing or services necessary to maintain the physical or mental health of an older person or a person with a developmental disability without lawful authority, as described in 52-3-803, MCA. A declaration made pursuant to 50-9-103, MCA constitutes lawful authority.

(2) "Advocate" means a person who:

(a) represents the interests and rights of a person receiving services consistent with the person's interests;

(b) is not an employee of any agency directly providing services to the person receiving services; and

(c) who is acknowledged by the person receiving services to be the person's advocate currently.

(3) "Applicant" means a person who applies for services, but is not yet accepted into a service program.

(4) "Board" means three meals a day or any other full nutritional regimen. A meal furnished as part of an adult day care program is not considered board.

(5) "Case manager" means the person, employed by either a contractor or the division, who assesses individual service needs, assists individuals to access services, coordinates the planning process, monitors services delivered, and provides crisis management.

(6) "Contract" means any contractual agreement, inclusive of appendices and other duly incorporated writings, for the delivery of services to persons with developmental disabilities entered into by the department with the contractor.

(7) "Contractor" or "provider" means any person or entity providing developmental disabilities services to persons with developmental disabilities through a contract with the department.

(8) "Developmental disabilities services" means the state program of services for persons with developmental disabilities managed through the developmental disabilities program of the department.

(9) "Person with a developmental disability" or "developmentally disabled person" means a person who has a developmental disability as defined in 53-20-202(3), MCA.

(10) "Direct care staff" means a person employed by a contractor in a position the duties of which focus on the hands on delivery of services to persons with developmental disabilities or to their families or both. Direct care tasks include: monitoring and delivering basic life and health care needs, implementing programs, intervening when maladaptive behaviors occur, recording progress toward meeting goals and objectives, documenting incidents, and sharing information with supervisory staff or other professionals according to the policies and procedures of the contractor. In outreach services, direct care tasks may include conducting home visits and providing specialized instruction to family members in the implementation of programs to meet individual needs.

(11) "Program" means the developmental disabilities program of the department of public health and human services.

(12) "Emergency response system" means a system which can be efficiently operated by staff or where appropriate, individuals, that ensures the safety of the people in the home or the facility in an emergency. The system includes well-rehearsed emergency procedures for the people living and working in the facility. The system includes, in addition to emergency response measures, a reliable means of communicating with on-call staff and other people who are available in the event of an emergency. The means of communication may include an immediate electronic access to ambulance, fire department, medical staff, police and other staff within the corporation.

(13) "Evaluation" means a process for making determinations regarding whether disabling conditions are present, determining individual needs and making specific recommendations or selecting treatment alternatives to address those needs.

(14) "Exploitation" means the unreasonable use of an older person or a person with a developmental disability, the person's money or the person's property to the advantage of another by means of duress, menace, fraud or undue influence.

(15) "Family" means natural parents, adoptive parents, foster parents, grandparents, guardians, stepparents, or others with whom a child lives and non-custodial parents and other persons who are legally responsible for the child's welfare.

(16) "Habilitation" means the process to assist a person with developmental disabilities in acquiring and maintaining those life skills which enable the person to cope more effectively with the demands of the environment and to improve physical, mental and social efficiency. Habilitation includes, but is not limited to, formal structured education and treatment.

(17) "Incidents" means significant events, acts or omissions not otherwise permitted which result or may result in physical or emotional harm to an individual or which intentionally deprive an individual of acknowledged rights, including, but not limited to:

(a) death;

(b) harm or illness requiring hospitalization;

(c) complaints or illness of an extended nature;

(d) harm of a staff member due to actions of an individual;

(e) suicide attempts;

(f) a substantial change in residential or work placement without approval of the individual planning team;

(g) alleged unlawful activities by or affecting an individual;

(h) abuse, exploitation, neglect or sexual abuse;

(i) rights violations;

(j) an unaccounted for absence;

(k) significant property damage; or

(l) any behavior requiring the use of an emergency procedure as provided for in ARM 37.34.1401 et seq.

(18) "Integrated/inclusive community activities" means enjoyable activities that provide an individual with opportunities to participate with other members of the community.

(19) "Leisure activities" means enjoyable recreational and other activities in which an individual may actively participate.

(20) "Neglect" means the failure of a guardian; an employee of a public or private residential institution, facility, home or agency; or any person legally responsible in a residential setting for the welfare of an older person or a person with a developmental disability to provide, to the extent of legal responsibility, food, shelter, clothing or services necessary to maintain the physical or mental health of the older person or the person with a developmental disability.

(21) "Organized health care delivery systems" means an organized system of health care delivery which allows for both the direct provision of health care services as well as contracting with other qualified providers to furnish services required by an individual's plan of care.

(22) "Plan of care" means a written plan identifying the supports and services that are necessary to achieve independence, dignity, and personal fulfillment, developed for a person with developmental disabilities by the planning team on the basis of a skill assessment and determination of the strengths and needs of the person.

(23) "Planning team" means an interdisciplinary team composed of those persons specified in ARM 37.34.1107 that identifies and evaluates the needs of a person receiving services, develops a plan of care to meet those needs, periodically reviews the person's response to the plan and revises the plan accordingly.

(24) "Portability" means providing for contract funds used to support the individual in the current placement to be transferred to a new service contractor when an individual receiving services moves to another geographical area of the state or obtains services from another qualified provider contract.

(25) "Positive behavior support" means the application of a variety of behavior modification procedures and techniques to change undesirable behaviors, with an emphasis on minimizing the use of punishers and aversive programming.

(26) "Regional manager" means a person employed by the developmental disabilities program in one of five field-based supervisory positions.

(27) "Room" means shelter type expenses including all property related costs such as rental or purchase of real estate and furnishings, maintenance, utilities and related administrative services.

(28) "Sexual abuse" means the commission of sexual assault, sexual intercourse without consent, indecent exposure, deviate sexual conduct or incest, as described in Title 45, chapter 5, part 5, MCA.

(29) "Standards" means criteria developed by various sources and used by the department for the purpose of judging the adequacy of the quality and extent of service provided by providers to persons with developmental disabilities.

(1) The division must provide for the evaluation of any person eligible for diagnostic and evaluation services either through services funded by the department or by referral to another agency.

(2) Under ARM 37.34.1101 et seq., within 30 calendar days of the enrollment of a developmentally disabled person in a provider service program, with the exception of respite and transportation services, the provider must perform a comprehensive skill assessment for that person. Each assessment must be reviewed annually by the provider. Results of the assessment must be provided to the person's planning team, including the person receiving services.

(1) Confidential information, for purposes of this chapter, includes the following information about any person applying for or receiving services through the developmental disabilities program:

(a) name, address, and phone number;

(b) the amount or type of services provided;

(c) information related to the social and economic conditions or circumstances;

(d) agency evaluation of information;

(e) medical data, including diagnosis, treatment, and past history of disease or disability;

(f) educational, training, habilitation or any similar data;

(g) any of the above information pertaining to the immediate family members.

(2) The department and the provider must not disclose confidential information concerning the person except to department staff and providers who assist in eligibility determination, referral, or the provision of services to the person.

(3) Information, as specified, may be disclosed upon the written consent of:

(a) the person if a legally competent adult; or

(b) the person's parents, if legally responsible for the person, or the legal representative of the person.

(4) Information may be disclosed if it is in summary, statistical, or any other form which does not identify and cannot be used to identify the person.

(5) Information may be disclosed pursuant to a court order issued by a court of competent jurisdiction, to the extent required by the court order.

(6) Information may be disclosed to the extent required to take immediate life-saving measures.

(7) Information may be disclosed to the extent required by federal or state law.

(8) The disclosure of any information related to the person will be governed by requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the requirements of Title 45 Part 160 and 164 of the Code of Federal Regulations (CFR) and all other applicable state and federal laws protecting the person's privacy.

(1) Providers must have a written grievance procedure, approved in writing by the department prior to implementation, for resolution of grievances brought by persons receiving developmental disabilities services.

(2) The procedure must provide for resolution of a grievance within 45 days of receipt of the grievance. Resolution may be extended beyond 45 days only with written approval by the department.

(3) The person must exhaust the provider's grievance procedure before appeal of the matter may be made to the department under the provisions of ARM 37.5.304, 37.5.305, 37.5.307, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

(4) Upon entry into a program and annually thereafter, the provider must advise the person of their right to present grievances. The provider must assist persons, as may be necessary, in utilizing the grievance procedure.

(2) Assistance and supervision may only be given where a medication which is normally self-administered has been prescribed for the person and where the medical professional who prescribed the medication also prescribed assistance or supervision in the administration of the medication.

(3) For the purposes of this rule, the following definitions apply:

(a) "Assistance" means providing any degree of support or aid to a person who independently performs at least one component of medication-taking behavior.

(b) "Supervision" means critically observing and directing a person engaged in medication-taking behavior.

(4) An employee or an agent of a provider, in order to assist or supervise in the administration of prescribed medication to persons, must be certified by the department as herein provided unless the employee or the agent is otherwise authorized by law to provide such assistance or supervision.

(5) To be certified, an employee or agent of a provider must demonstrate knowledge of health issues relating to persons with developmental disabilities including general health, health emergencies, aspiration pneumonia, seizure disorders, and knowledge of the use and side effects of medications by achieving a score of at least 85% on a comprehensive test administered by the department.

(6) Application for certification to provide supervision and assistance in the administration of medication is made by submitting a request to be certified to the Department of Public Health and Human Services, Developmental Disabilities Program, P. O. Box 4210, Helena, MT 59604.

(7) Any provider may receive, free of charge, an instructional and reference aid entitled Health and Medication Administration Manual for Individuals with Developmental Disabilities: A Self-Paced Study Guide and Reference Manual as adopted by the department in ARM 37.34.113.

(8) The department, or an agency determined by the department, administers the comprehensive test to a qualified applicant within 30 days of receipt of the request for certification.

(9) Notice of certification or noncertification is mailed by the department within ten days of the date of testing. A notice of certification designates an effective date and an expiration date for the certification. The certification period may be for no more than a maximum of two years.

(10) A person may receive consecutive certification by retaking the test as provided in (5) through (8).

(11) Each provider shall maintain a current list of employees and agents certified to supervise and assist in the administration of medication.

(12) If a person has been receiving developmental disabilities services for 30 days and supervision and assistance is to be administered for more than ten consecutive days, this activity must be included as an objective in the written plan of care. To address the objective, an individual program plan must be prepared which describes a program to train the person to self-administer the medication and must specify at least:

(a) the target medication-taking behavior;

(b) the conditions under which such behavior should occur;

(c) the conditions under which such behavior will be trained;

(d) the criterion for completion of the individual program plan in accordance with (14);

(e) the written strategies for training the target behavior;

(f) a data recording system which accounts for each prescribed medication dosage; and

(g) a daily data recording system which specifies progress or lack of progress toward the target behavior.

(13) Every instance of assistance or supervision provided under this rule must be recorded and must include at least the name of the person who receives medication, the name of the person who assists or supervises the taking of medication, the date and time the medication was taken, and the type of medication taken.

(14) A person is considered to be capable of self-administering medication when it has been documented that the person has self-administered all (100%) of prescribed medication dosages for a consecutive 30-day period.

(15) There are two conditions under which an individual program plan to teach self-administration of medication is no longer necessary. They are:

(a) the person has met the criterion specified in (14); or

(b) the planning team has reviewed the ongoing implementation of the individual program plan and found that the person has reached the maximum level of independence in the self-administration of medication of which the individual is currently capable. In making this decision, the team must evaluate whether:

(i) the person has made any progress;

(ii) the program has been consistently implemented;

(iii) a variety of teaching strategies has been employed;

(iv) the decision to discontinue the program will interfere with the person's ability to be served in a less restrictive environment; and

(v) the program has been in place long enough to make a decision concerning its effectiveness.

(16) If the planning team decides that an individual program plan to teach self-administration of medication is no longer necessary, the requirements concerning the need for certified personnel and recording instances of assistance and supervision must be met.

(17) The feasibility of re-instituting a program to teach self-administration of medication must be examined at subsequent meetings by the planning team. If the person's situation changes such that there is a possibility of further acquisition of the skill, a program must be initiated.

(18) The department may revoke or suspend a certification.

(a) The department may revoke certification by notifying the certified person of the reason for revocation in writing at least ten days prior to the effective date of revocation. The certified person may request, in writing, within the ten days prior to revocation, a review of the decision. A decision is issued within 30 days from the date the request for review is received. When a request for a review is made, the revocation is not effective until the review is completed and a final decision issued.

(b) The department may suspend a person's certification for a period no longer than 15 days, after which the suspension must be removed or notice of revocation issued. If notice of revocation is issued, suspension may continue until the effective date of revocation or until the decision is made.

(1) A person, in order to be considered for placement into a developmental disabilities services program funded through the Developmental Disabilities Program (DDP) of the department, must be determined by the department in accordance with the criteria of this rule to be a person with a developmental disability.

(2) The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual, 6th Edition, 2013, sets forth the requirements for eligibility of the DDP's service programs.

(3) Eligibility for the DDP service programs, with the exception of federally funded Part C services, must be determined in accordance with the requirements of the Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual, 6th Edition, 2013. A copy of the manual may be obtained from the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604 or at http://www.dphhs.mt.gov/dsd/ddp/EligibilityReferenceManual.pdf.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) On July 1, 2011, funding will terminate for all persons 19 years of age or older who were receiving developmental disability community services as of February 28, 2011 and funded by a combination of the state general fund and the federal Title XX Social Services Block Grant.

(a) Persons subject to this loss of state general fund and federal Title XX Social Services Block Grant funding may continue to receive developmental disabilities services if they apply for and are determined by the department to meet the following:

(i) the financial and categorical eligibility for the Medicaid program; and

(ii) the eligibility criteria for one of the Medicaid funded programs of home and community developmental disabilities services and are accepted into that program.

(b) For persons who have as of July 1, 2011 applied for Medicaid eligibility, but for whom Medicaid eligibility has yet to be determined, their services may be continued with Title XX Social Services Block Grant funding during the pendency of this eligibility application.

(2) For persons, 19 years of age or older, who as of February 28, 2011 were in receipt of developmental disability community services funded by a combination of the state general fund and the federal Title XX Social Services Block Grant and who are ineligible for Medicaid funded services or who are ineligible for or not accepted into a Medicaid funded developmental disabilities home and community services program, the department may, in its discretion, on or after July 1, 2011, proceed to fund developmental disabilities community services for the person with federal Title XX Social Services Block Grant funding if such funding is available.

(3) The department may apply available federal Title XX Social Services Block Grant funding under this rule to establish the eligibility of a person for developmental disabilities community services by using the method set forth in the documents dated and effective June 9, 2011 entitled "Application for Federal Title XX Social Services Block Grant Funding" and "Directions for Federal Title XX Social Services Block Grant Funding". The department adopts and incorporates those documents by reference. The documents are available from the Developmental Disabilities program, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604, and at www.dphhs.mt.gov/dsd/ddp/forms.shtml.

(4) Persons, 19 years of age or older, for whom neither Medicaid funding nor federal Title XX Social Services Block Grant funding is available will no longer be eligible to receive services from the developmental disability services program.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(2) The purpose of family education and support services is to obtain or provide resources, support, training and assistance designed to assist a child and to enhance the capacity of a family to promote the development of a child.

(3) The purpose of children's community home services is to provide a healthy and safe living environment to meet the needs of children with intensive developmental disabilities who no longer reside with a natural or foster family. This living arrangement supports a child's overall development, provides opportunities for socialization and the development of leisure skills, and facilitates integration into community life.

(4) These rules define services and describe the specific services available, program components, program requirements and limitations, contractor performance requirements, and education and training requirements.

(5) The definitions used for federally funded intensive home and community family education and support services, except for those in ARM 37.34.602, are at ARM 37.34.901, et seq.

These definitions apply to all family services.

(1) "Children's community home" means a licensed, home-like living arrangement in which 2 to 6 children with developmental disabilities who are between 5 and 22 years of age and have intensive needs, reside under the general care and supervision of community home staff.

(2) "Children's community home services" means residential services for children with developmental disabilities who have intensive needs and who are unable to reside with their families or with a foster family. Children's community home services provide children with physical care, guidance, resource and service coordination, and direct instruction based on developmental models and principles of normalization. Children's community home services include:

(a) providing a community-based residential alternative to natural and foster homes;

(b) helping children with disabilities reach their maximum developmental potential;

(c) coordinating the provision of individualized services for children such as special education, day services, recreation, and other community-based services; and

(d) assisting children with disabilities to increase their level of personal independence, move on to less restrictive settings, and lessen their reliance on the service system.

(3) "Children's summer day services" mean day services occurring during the summer that provide both formal and informal functional education and training and leisure and recreational activities designed to promote development, independence, and acquisition of individual skills. Training is provided in such areas as self-help, social, language, pre-academic, academic, motor and prevocational.

(4) "Core services" means those services available to all children and families based on needs identified in the individual family service plan (IFSP) . Core services include evaluation and assessment, individualized family service plan, support coordination, information and referral, and procedural safeguards.

(5) "Evaluation and assessment" means a process for determining a child's initial and continuing eligibility for services. The evaluation process is a responsive and individualized set of procedures for completing the eligibility determination process in a fair and timely fashion.

(6) "Family" means natural parents, adoptive parents, foster parents, grandparents, guardians, stepparents or others with whom a child lives, and persons who are legally responsible for the child's welfare.

(7) "Family education and support services" means types of services that provide resources, supports and assistance designed to assist a child and to enhance the capacity of a family to promote the development of a child. The family, in partnership with program staff, establishes priorities and assists in the development, implementation and evaluation of the IFSP. Family education and support services include:

(a) helping children with disabilities reach their maximum potential;

(b) keeping children with their families in their home communities;

(c) assisting families in maximizing their skills and abilities to utilize generic and specialized resources; and

(d) helping families avoid unnecessary reliance on the service delivery system.

(8) "Family services" means family education and support services, children's community home services, and children's summer day services.

(9) "Family support specialist" means a person employed by a family services contractor to deliver support coordination services.

(10) "Individual educational program" (IEP) means, as defined at ARM 10.16.1207, a plan of outcomes and objectives which address a child's educational strengths and deficits.

(11) "Individualized family service plan" (IFSP) means a written plan for organizing and directing the delivery of family education and support services to a child and the child's family. The plan includes information regarding a family's concerns and priorities for resources, supports and assistance. The plan helps each family establish and achieve its goals. The plan is part of a dynamic planning process undertaken by an interdisciplinary team. The family is the primary member of the team and is the final decision maker.

(12) "Information and referral" means assistance by contractor staff in informing families not currently served of program criteria, evaluations, and providing direction to the most appropriate available resources which may meet their needs. Information and referral includes investigating the availability and appropriateness of various resources, explaining the options available to the family, and contacting the agencies on behalf of the family. Information and referral also includes the provision of information requested by families previously served.

(13) "Parent" means a natural parent, guardian, or a person acting as the parent of a child, or a surrogate parent who has been appointed in accordance with federal statute. The term includes grandparents, stepparents, or others with whom a child lives, and persons who are legally responsible for the child's welfare. The term does not include the state.

(14) "Procedural safeguards" mean measures to provide a child and family with appropriate involvement in the planning, development, and provision of services and to provide due process concerning decisions that they believe adversely affect the provision of services.

(15) "Resource and support wrap-around services" means items or services obtained or provided for the purpose of accomplishing IFSP objectives. These services may include assistive technology, audiology, support coordination, family education, counseling, home visits, health, nursing, nutrition, occupational therapy, physical therapy, psychology, social work, special instruction, speech-language pathology, transportation, and vision services. The component services of resource and support wrap-around services for purposes of state-funded family education and support services and for federally funded Part H family education and support services are defined in ARM 37.34.604. The component services of resource and support wrap-around services for purposes of federally funded intensive family education and support services are defined at ARM 37.34.901, et seq.

(16) "Support coordination" means assistance and services provided by a family support specialist or an intensive support coordinator to assist and enable a child and the child's family to receive the rights, procedural safeguards, and services that are provided through the family education and support services programs. Support coordination includes:

(a) assisting a family to access or modify existing community resources, both formal and informal;

(b) assisting a family to gain access to, facilitating the timely delivery of, and coordinating and monitoring the resources and services identified in the IFSP;

(c) coordinating all activities associated with the development, implementation, and evaluation of an IFSP;

(d) maintaining a record of support coordination activities in each child's record;

(e) coordinating the performance of evaluations, assessments and family information gathering activities;

(f) coordinating and monitoring the delivery of available resources;

(g) informing the family of legal rights related to special services;

(h) informing families of the availability of advocacy services;

(i) coordinating with medical and health providers when requested by the family;

(j) facilitating the development of a transition plan to other services; and

(k) completing referral information when the child is ready to move to a new service.

(1) "Assistive technology devices" means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of children with disabilities.

(2) "Assistive technology services" means services that directly assist a child with a disability in the selection, acquisition, or use of an assistive technology device. Assistive technology services include:

(a) evaluating the needs of a child with a disability, including a functional evaluation of the child in the child's customary environment;

(b) purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for children with disabilities;

(c) selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;

(d) coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing early intervention and rehabilitation plans and programs;

(e) training or technical assistance for a child with disabilities or, if appropriate, that child's family; and

(f) training or technical assistance for professionals including persons providing early intervention or rehabilitation services, or other persons who provide services to, or are otherwise substantially involved in the major life functions of children with disabilities.

(3) "Audiology services" means the identification of children with auditory impairment, using at risk criteria and appropriate audiologic screening techniques. Audiology services include:

(a) determining the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures;

(b) referral for medical and other services necessary for the habilitation or rehabilitation of children with auditory impairment;

(c) providing auditory training, aural rehabilitation, speech reading and listening device orientation and training, and other services;

(d) providing services for prevention of hearing loss; and

(e) determining the child's need for individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.

(4) "Family education, counseling, and home visits" means services provided, as appropriate, by family support specialists, and other qualified personnel, including but not limited to, psychologists, professional counselors and social workers, to assist the family of a child in understanding the special needs of the child and how to enhance the child's development.

(5) "Full service" means services, supports and resources furnished to a child and family eligible for federally funded Part H family education and support services or for state funded family education and support services. The child and family are served in accordance with an IFSP, through service coordination provided at a minimum of one staff contact per month. This service provides access to resources and support wrap-around services.

(6) "Health services" means medical services necessary to enable a child to benefit from other family education and support services during the time the child is receiving family education and support services.

(a) Health services include, but are not limited to, clean intermittent catheterization, tracheostomy care, tube feeding, the changing of dressing or colostomy collection bags, other health services, and consultation by physicians with other service providers concerning the special health care needs of children that will need to be addressed in the course of providing other early intervention services.

(b) Health services do not include services that are surgical, medical or medical-health in nature. Excluded services include, but are not limited to, cleft palate surgery, surgery for club foot, the shunting of hydrocephalus, hospitalization or management of congenital heart ailments, the prescribing of medicine or drugs for any purpose, devices necessary to control or treat a medical condition, immunization and regular well-baby care routinely recommended for all children.

(7) "Medical services only for diagnostic or evaluation purposes" means services provided by a licensed physician to determine a child's developmental status and need for family education and support services.

(8) "Nursing services" means the provision of medically necessary nursing care as prescribed by a medical professional. Nursing services include:

(a) assessing health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems;

(b) providing nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; and

(c) administering medications, treatments, and regimens prescribed by a licensed physician.

(9) "Nutritional services" means services to maintain and improve the nutrition of a person. Nutritional services include:

(a) individual assessments in nutritional history and dietary intake, anthropometric, biochemical, and clinical variables, feeding skills and feeding problems, and food habits and food preferences;

(b) developing and monitoring appropriate plans to address the nutritional needs of a child based on the child's individual needs assessment; and

(c) referral to appropriate community resources to carry out nutrition goals.

(10) "Occupational therapy services" means therapy services to address the functional needs of a child related to adaptive development, adaptive behavior and play, and sensory, motor, and postural development. These services are designed to improve the child's functional ability to perform tasks in home, school, and community settings. Occupational therapy services include:

(a) identification, assessment, and intervention;

(b) adapting the environment, and selecting, designing and fabricating assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and

(c) preventing or minimizing the impact of initial or future impairment, delay in development, or loss of functional ability.

(11) "Physical therapy services" means therapy services to enhance sensorimotor function through therapies addressing musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation. Physical therapy services include:

(a) screening, evaluation, and assessment of the child to identify movement dysfunction;

(b) obtaining, interpreting, and integrating information appropriate to program planning, to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and

(c) providing individual and group services to prevent, alleviate or compensate for movement dysfunction and related functional problems.

(12) "Psychological services" means services to assess a person's mental or developmental status. Psychological services include:

(a) administrating psychological and developmental tests, and other assessment procedures;

(b) interpreting assessment results;

(c) obtaining, integrating, and interpreting information about child behavior, and child and family conditions related to learning, mental health, and development; and

(d) planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, parent training, and education programs.

(13) "Social work services" means services to improve a person's social well-being. Social work services include:

(a) making home visits to evaluate a child's living conditions and patterns of parent-child interaction;

(b) preparing social or emotional developmental assessments of the child within the family context;

(c) providing individual and family-group counseling with parents and other family members and appropriate social skill-building activities with the child and parents;

(d) working with problems in a child's and family's living situation where family education and support services are provided that affect the child's maximum utilization of family education and support services; and

(e) identifying, mobilizing, and coordinating community resources and services to enable the child and family to receive maximum benefit from family education and support services.

(14) "Special instruction services" means the design of learning environments and activities to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction. Special instruction services include:

(a) planning curriculum, including the planned interaction of personnel, materials, and time and space, to achieve the outcomes in the child's IFSP;

(b) providing families with information, skills and supports to enhance the skill development of the child; and

(c) working with the child to enhance the child's development.

(15) "Speech-language pathology services" means services to enhance a person's speech and language skills. Speech-language pathology services include:

(a) identifying children with communicative or oropharyngeal disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills;

(b) referral for medical or other professional services necessary for the habilitation or rehabilitation of children with communicative or oropharyngeal disorders and delays in development of communication skills; and

(c) providing of services for the habilitation, rehabilitation, or prevention of communicative or oropharyngeal disorders and delays in development of communication skills.

(16) "Transportation services" means providing the cost of travel, including but not limited to mileage or travel by taxi, common carrier, or other means, and related costs. Related costs include, but are not limited to, parking expenses necessary for a child and the child's family to receive family education and support services.

(17) "Vision services" means services to enhance or to compensate for vision loss. Vision services include:

(a) evaluating and assessing visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities;

(b) referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and

(c) training in communication skills, orientation and mobility for all environments, visual, independent living skills, and other skills necessary to activate visual motor abilities.

(18) "Other services" means family education and support services that are identified in the IFSP and that are useful in meeting the developmental needs of the child and the concerns and priorities of the family.

(19) "Respite services" means services to relieve the stress of constant care. Respite care services include, but are not limited to, respite care hours, transportation, and recreation or leisure activities for the child and family. These services are designed to meet the safety and daily care needs of each child and the needs of the child's family so as to reduce family stress generated by provision of constant care to a family member with a developmental disability. Respite services are provided based on the availability of funds.

(1) "Annual service agreement" means a yearly plan developed with a family to provide limited or follow-along family education and support services.

(2) "At risk" means a child, from birth to 6 years of age, who is at risk of a delay in development or of having a developmental disability due to environmental risk, established risk, or biological risk.

(3) "Biological risk" means a child who has a probability of aberrant development due to a history of prenatal, perinatal, neonatal, and early development events suggestive of biological insult to the developing central nervous system. The events, either singly or collectively, increase the probability of later appearing aberrant development.

(4) "Child education" means education that enables family members to conduct specific skill acquisition, stimulation, or behavioral intervention programs with the child.

(5) "Environmental risk" means a biologically sound child who has a high probability of developmental delay due to life experiences unless there is corrective intervention. Life experiences that may contribute to developmental delay include maternal and family care, health care, opportunities for expression of adaptive behaviors, and patterns of physical and social stimulation that are sufficiently limiting.

(6) "Established risk" means a child has a probability of developmental delay due to early appearing aberrant development that is related to diagnosed medical disorders of known etiology bearing relatively well known expectancies for developmental delay.

(7) "Family education" means education that enables family members to function as independently as possible in providing or obtaining services and supports for the child so that reliance on services is minimized or eliminated.

(8) "Follow-along service" means support coordination services developed and provided in accordance with an annual service agreement for one to four staff contacts per year.

(9) "Limited services" means services, supports and limited resources furnished to a child and family. Limited services are developed and provided in accordance with an annual service agreement. Limited services may include up to 4 staff contacts per year.

(2) The department will enter into contracts with entities to provide family services.

(3) A contractor providing family services must comply with the performance requirements in this rule and the contract.

(4) All facilities, other than the parent's home, used in the provision of services must meet all applicable licensure requirements and health and safety codes.

(5) Policies and procedures must be maintained and implemented to ensure:

(a) a safe, healthy environment for all children served; and

(b) the safe transport of all children.

(6) Supervision, support, care, education, training, health monitoring and medical assistance must be provided in accordance with the needs of the child and as specified by the IFSP or IP team.

(7) Planning teams, in the planning for the provision of services, except for federally funded Part H family education and support services, must consider the level of services the individual is enrolled in and the availability of funds when making decisions regarding specific services to be provided.

(8) An emergency response system must be maintained as specified in the contract to assist children and staff for emergencies such as medical problems, behavior intervention, disasters, and other similar emergencies.

(9) The contractor must participate in the IFSP or IP team process recommending objectives, as applicable, to the team for each child.

(10) Any activities of the IP or IFSP assigned to the contractor must be implemented.

(11) Transportation must be coordinated to assist each family in meeting the child's needs.

(2) A contractor providing family education and support services must comply with the performance requirements in this rule and the contract.

(3) Core services must be provided to all families except those families who participate in limited or follow-along services.

(4) The evaluation and assessment process must consider the unique characteristics of the child, the accumulated information about the child, and the child's parents' choices regarding evaluation alternatives.

(a) During initial and ongoing contacts in the evaluation and assessment process, the child must be continually assessed and matched to eligibility requirements for available resources provided by the contractor or other service delivery systems.

(b) The evaluation and assessment process must provide the child's parents with appropriate information for making informed decisions regarding service options for their child and family.

(c) The evaluation and assessment process must be individualized in nature, must be based on the family's primary developmental and functional concerns regarding the child, and must address the child's specific characteristics.

(5) Information and referral must be provided on an as- needed basis. Information and referral to more appropriate services must be provided to children found to be ineligible for developmental disabilities services.

(6) The individualized family service plan (IFSP) must direct the provision of assistance and services to the child.

(a) The needs of the child and the family must be identified and prioritized in the IFSP.

(b) The methods and outcomes established through the IFSP must be consistent with the family's priorities and values.

(c) The family must be allowed to participate in the planning process at the level they find most comfortable. The family must receive written notification of all team meetings and may request written notification of other team members.

(d) The IFSP must meet with the approval of the family.

(e) The IFSP must include every service provided to the child and family.

(f) The funding source for each objective in the IFSP must be identified.

(g) The IFSP must include objectives and prescriptive programs related to the accomplishment of child education outcomes.

(h) Decisions as to the services, resources and supports to be provided must be made with consideration of the level of services the child is receiving and the availability of funding.

(7) Family service records must be maintained documenting each contact with or on the behalf of a child or family and describing the services provided.

(8) The IFSP must be evaluated, revised or rewritten in response to family need or as otherwise necessary.

(9) Support coordination must serve to obtain the supports and services as specified in the IFSP.

(a) Support coordination may only be provided by a family support specialist, an intensive support coordinator, or a family member.

(b) Support coordination manages the delivery of services so as to assure usage of other appropriate services before the IFSP may attempt to develop any new resource to meet an identified need.

(c) Family members may choose to take responsibility for completing certain support coordination activities in accordance with the IFSP.

(d) Each family must be assigned a family support specialist responsible for monitoring support activities.

(10) Respite services must be provided in conformity with an IFSP or an annual service agreement developed with the family.

(a) Respite services are selected in collaboration with the family.

(b) The family selects the persons to provide respite care.

(c) Respite services are provided based on the availability of funds.

(11) Procedural safeguards must be accorded to children and families receiving family education and support services.

(a) Parents must be provided the opportunity to examine, inspect or review records relating to evaluations, assessments, eligibility determination, IFSP development and implementation, individual complaints dealing with the child, and any other areas involving records about the child and the child's family.

(b) Parents must be given prior notice for matters of eligibility, evaluation, or placement of the child. Notice must be effectively given by means of native language or other communication form when appropriate.

(c) Parental prior consent must be given in writing for:

(i) conducting the initial evaluation, child assessment, and family information gathering;

(ii) initiating the provision of services for the first time, or any time a change in service is being considered; and (iii) the exchange of personally identifiable confidential information.

(d) Parents must be allowed to decline all services or a specific service. Declining a service must not jeopardize the receipt of other services.

(e) A surrogate parent must be appointed when:

(i) no parent can be identified;

(ii) the division, appropriate state agency, or the family services agency cannot discover the whereabouts of a parent after engaging in reasonable efforts; or

(iii) the child is a ward of the state under law.

(f) Personally identifiable information must be kept confidential.

(g) An adverse decision affecting services to the child or family may be appealed.

(i) A decision must be appealed through the internal grievance procedures of the contractor. If a resolution cannot be reached with the contractor, the decision is appealable under the provisions of ARM 46.2.202, et seq.

(ii) For federally funded Part H family education and support services, a decision must be appealed through the internal grievance procedures of the contractor. If a resolution cannot be reached with the contractor, the decision is appealable in accordance with the procedures for resolving complaints regarding federally funded Part H early intervention services as provided by federal rule at 34 CFR 303.420 through 303.425. The department hereby adopts and incorporates by reference the impartial procedures for resolving individual child complaints regarding federally funded Part H early intervention services published, July 1, 1994, by the United States department of education, at 34 CFR 303.420 through 303.425.

(h) Each family must be provided with a copy of procedures for appealing decisions made by the contractor.

(i) Child and family participation in family services is on a voluntary basis.

(12) An annual consumer satisfaction survey of families who received services during the year must be conducted and the results provided to the department.

(13) A monthly waiting list must be submitted to the department's regional office according to procedures defined by the department.

(a) An inventory for client and agency planning (ICAP) must be completed and submitted for each child on the waiting list, each child enrolled in services, and upon initial enrollment, for each child waiting for or receiving limited or follow-along services.

(14) Family education and support services staff assist a family in selecting and training providers to achieve identified IFSP outcomes.

(a) A family generally may select and train providers of resource and support wrap-around services. In certain circumstances requiring specialized training, family education and support services staff may recruit, screen, and interview potential providers.

(15) Family education and support services staff monitor and document service delivery.

(2) A contractor providing state funded family education and support services, including limited and follow-along service, must comply with the performance requirements in this rule and the contract.

(3) The family of a child receiving limited service must have at least one annual face-to-face visit with contractor staff to develop an agreement with the family to provide access to limited resources and up to three additional support coordination contacts per year.

(4) The family of a child receiving follow-along service must have at least one annual face-to-face visit with contractor staff to develop an agreement with the family to provide up to three additional support coordination contacts per year.

(5) The contractor must recruit and maintain an up-to-date list of persons who are available to provide respite care within the geographic area served by the contractor.

(a) All persons who are recruited and maintained on the list must receive orientation.

(b) Orientation must at the minimum include:

(i) familiarization with the contractor corporation and its role in the provision of respite services; and

(ii) familiarization with a family information profile form and procedures for using the profile.

(1) Federally funded Part H family education and support services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing federally funded family education and support services must comply with the performance requirements in this rule and the contract.

(3) All services must be provided in accordance with the policies and procedures contained in Montana's state plan under Part H of the Individuals with Disabilities Education Act as approved by the United States department of education. The department hereby adopts and incorporates by reference the Montana state plan under Part H of the Individuals with Disabilities Education Act as approved November, 1994, by the United States department of education. A copy of the plan may be obtained from the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(4) All services available through other accessible funding sources must be provided through those other funding sources prior to any expenditure for those services through federally funded Part H family education and support services.

(5) The contractor must recruit and maintain an up-to-date list of persons who are available to provide respite care within the geographic area served by the contractor.

(a) All persons who are recruited and maintained on the list must receive orientation.

(b) Orientation must at the minimum include:

(i) familiarization with the contractor corporation and its role in the provision of respite services; and

(ii) familiarization with a family information profile form and procedures for using the profile.

(2) Resource and support wrap-around services are available for a child and family eligible under federally funded Part H family education and support services.

(3) Resources and support wrap-around services are available for a child and family under state funded family education and support services only as availability of funding allows.

(1) Federally funded intensive family education and support services must be provided in accordance with the performance requirements in this rule.

(2) A contractor providing federally funded intensive family education and support services must comply with the performance requirements in this rule and the contract.

(3) Services must be provided in accordance with the general rules governing home and community services for persons with developmental disabilities at ARM 37.34.901, et seq.

(4) A contractor must be a designated organized health care delivery system.

(5) All services available through other accessible funding sources must be provided through those sources prior to any expenditure through federally funded intensive family education and support services.

(6) At least one contact each month with or on behalf of a family for the purpose of providing support coordination, direct services or to provide supervision and consultation to subcontracted personnel must be documented.

(7) The residential status of each child on the caseload must be reported to the regional manager at the beginning of the fiscal year.

(8) All possible or actual movement from a natural home or a foster home must be reported to the regional manager as soon as possible.

(9) Recruitment activities must be done for the purpose of securing and maintaining foster families willing to consider long-term placement, including shared care or back-up foster families, respite providers and emergency placement providers.

(a) Recruitment activities and results must be coordinated with the department of family services.

(b) Families interested in providing foster care must be screened in cooperation with the licensing agency.

(10) No more than one person with severe disabilities may be placed in a home.

(11) A foster family under consideration must meet the child and, when possible, the child's natural parents, and a trial visit must take place prior to the decision regarding placement.

(12) Documentation of agreements with families and subcontracted personnel to provide paid habilitation services must be maintained.

(13) Habilitation programs must be carried out in accordance with each child's IFSP.

(14) A cost projection sheet corresponding to the plan of care must be developed at no less than 6 month intervals. The cost projection sheet must conform to allowable costs and identify funding sources.

(15) A contractual requirement that intensive family support funds be portable to another qualified intensive family support contractor must be complied with.

(16) Each family on the waiting list must be contacted at least annually to determine their continuing need for services and provide information and referral.

(17) Selection for a service opening must be made in accordance with departmental procedures.

(a) The department's regional office must be notified of service openings.

(b) Each family on the waiting list must be informed of any service openings.

(c) Written notice of screening decisions must be provided to interested families. Written notice includes description of the department's procedure for requesting a fair hearing.

(18) The provision of services to eligible children must be reported on a separate quarterly and final expenditure report for Montana's home and community services program for persons with developmental disabilities.

(19) The contractor must recruit and maintain an up-to-date list of persons who are available to provide respite care within the geographic area served by the contractor.

(a) All persons who are recruited and maintained on the list must receive orientation.

(b) Orientation must at the minimum include:

(i) familiarization with the contractor corporation and its role in the provision of respite services; and

(ii) familiarization with a family information profile form and procedures for using the profile.

(2) A contractor providing children's community home services must comply with the performance requirements in this rule and the contract.

(3) Children's community home services must ensure that the child's basic life and health care needs are met.

(4) A primary goal of children's community home services is to increase the independence of children with disabilities, especially in the areas of self-help, socialization, and community interaction.

(5) The provision of services must be based on the objectives set by each child's individual planning (IP) or individual education program (IEP) team.

(6) Residents must be provided a healthy, well-balanced diet and suitable clothing.

(7) Residents must be provided the care, habilitation and guidance necessary to meet the intensive needs.

(8) Physical care, supervision, and support must be provided according to the needs of the child.

(9) Policies and procedures must be maintained to ensure health monitoring and medical assistance is provided or secured for all children served.

(10) Weekly opportunities for a variety of integrated community activities must be provided unless otherwise specified by the IP team.

(11) Daily opportunities for a variety of leisure activities must be provided unless otherwise specified by the IP team.

(12) Facilities that the department determines are appropriate must be designed and configured so as to have the potential for certification according to ICF/MR licensing requirements for residents for whom self-evacuation is impractical.

(13) Provisions must be made in accordance with the requirements of the contract for children to remain at home during the day in cases of illness, episodic behavior, or individual schedules to accommodate service needs.

(14) Transition assistance must be provided for children and their IP teams as they move into a different setting or adult services.

(15) Education and training at a minimum must be provided in the following areas of skill development:

(a) individual self help skills, including but not limited to eating, dressing, bathing, toileting, attending to basic health care needs, telling time, and telephone use;

(b) social interaction skills, including but not limited to general manners, public behavior, sexual awareness and boundaries, and personal safety;

(c) independent living skills, including but not limited to clothing care and selection, household chores, cooking, response to emergencies, home repair and maintenance, leisure and recreational choices and skills; and

(d) community living skills, including but not limited to shopping, use of public or personal transportation, restaurant skills, and traffic safety skills.

(2) A contractor providing children's summer day services must comply with the performance requirements in this rule and the contract.

(3) The provision of services must be based on the objectives set by each child's individual planning (IP) or individual education program (IEP) team.

(4) Physical care, supervision, and support must be provided in accordance with the needs of the child.

(5) Weekly opportunities for a variety of integrated community activities must be provided, unless otherwise specified by the IP team.

(6) Daily opportunities for a variety of leisure activities must be provided, unless otherwise specified by the IP team.

(7) Transition assistance must be provided for children as they move into different settings or adult services.

(2) Services, in accordance with the individual planning process provided at ARM 37.34.1101, et seq., must meet the needs of the individual served. The individual, in partnership with service staff and significant others, establishes priorities, and participates in the development, implementation and evaluation of the individual plan (IP) . Planning teams, in planning for the provision of services, must consider the level of services the individual is enrolled in and the availability of funds when making decisions regarding specific services to be provided. IP objectives are designed to address areas in an individual's life where assistance is needed based on the assessments and desires of the individual. These areas may include living arrangements, work and day options, transportation, recreation and leisure, citizenship, relationships, and life management.

(3) Services must be provided in environments which enhance the quality of life for the individual. These environments must ensure that the individual's basic life and health care needs are met.

(4) Adult services must assist an adult with developmental disabilities to:

(a) enhance independence and interdependence with others in the community;

(b) expand options for participation in and contribution to society;

(c) increase skills and abilities to enable on-going personal growth; and

(d) reside, work and play in safe, healthy, integrated environments.

(5) The following principles must guide the provision of the assistance and services to an individual:

(a) The individual will have an increasing amount of control and choice in these services.

(b) The individual will have increasing options and flexibility available.

(c) The individual will have an opportunity for a good life with accompanying rights, responsibilities and risk.

(d) The location of activities and the interaction with other persons will be as integrated as possible in the community.

(e) The service will be as least intrusive in the person's life as possible.

(f) The principles of positive programming will be used.

(2) A contractor providing adult services, other than a contractor providing transportation services that are also available to the general public and contracting with the department to provide only transportation services, must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and the contract with the department.

(3) In the provision of adult services, the contractor must:

(a) ensure that all facilities used in the provision of services meet all applicable licensure requirements and health and safety codes;

(b) maintain and implement policies and procedures for a safe, healthy environment for all individuals served;

(c) maintain and implement policies and procedures which ensure health monitoring occurs and necessary medical assistance is provided or sought for all individuals served;

(d) provide supervision, support, care, education and training according to the needs of the individual and as specified by the IP team;

(e) implement any assigned activities of the IP;

(f) maintain and implement policies and procedures to assist individuals and staff in emergencies such as medical problems, behavior intervention, disasters, and other similar emergencies;

(g) participate in the IP team process, recommending objectives, as applicable, to the IP team for the individual;

(h) coordinate transportation to assist the individual in meeting the individual's needs;

(i) adhere to the service component definitions when specified in the contract; and

(j) provide additional or specialized services or requirements when specified in the contract.

(4) Service options and funding sources may have specific requirements that must be met.

(5) In the provision of intensive adult services, the contractor, in addition to the criteria in (3) , must:

(a) provide the level of care, habilitation and guidance necessary to meet the intensive needs of the individual; and

(b) ensure, when specified in the contract, other support services needs are addressed to enhance the ability of the individual to benefit from all services and activities.

(6) In the provision of senior services, the contractor, in addition to the criteria in (3) , must:

(a) implement a plan, when specified by the IP team, to allow the individual, based on individual interests and desires, to choose daily routines, including remaining at home.

(2) A contractor providing adult community home services must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and the contract with the department.

(3) Adult community home services are living arrangements in which 2 to 8 individuals, 16 years of age or older, reside with supervision, care, support and training. In addition to safe, comfortable housing, an individual is provided a healthy, well-balanced diet and is assisted in choosing, caring for and selecting for wear, suitable clothing. Community homes are available to meet a wide range of needs including those of individuals who have intensive or senior needs.

(4) In addition to these rules, community home contractors are required by 53-20-305 , MCA to meet the state of Montana licensing requirements for community homes for persons with developmental disabilities.

(5) Service options and funding sources may have specific requirements that must be met.

(6) In the provision of adult community home services, the contractor must provide:

(a) safe and comfortable housing;

(b) a healthy, well-balanced diet;

(c) assistance in choosing, caring for and selecting for wear, suitable clothing;

(d) weekly opportunities for a variety of integrated community activities unless otherwise specified by the IP team;

(e) daily opportunities for a variety of leisure activities unless otherwise specified by the IP team; and

(f) an emergency response system for an individual who is at home during the day without a staff person present. The contractor must have approval from the IP team prior to an individual remaining at home. The system must be approved by the IP team based on the capability of the individual to remain at home and to use the emergency response system.

(7) In the provision of intensive services, the contractor, in addition to the other requirements of this rule, must:

(a) ensure, when specified in the contract, that facilities are capable of being certified according to ICF/MR licensing requirements for residents for whom self-evacuation is impractical; and

(b) make provisions, when specified in a contract, to allow individuals to remain at home during the day in cases of illness, episodic behavior, or individual schedules to accommodate service needs, such as supported employment.

(2) A contractor providing work or day services must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and policies, and the contract with the department.

(3) Work or day services include facility-based services and community supported work activities. Supported work activities include individual supported employment, crews, enclaves, and volunteer work. Work or day services are available to meet a wide range of needs including those of individuals who have intensive or senior needs.

(4) Service options and funding sources may have specific requirements that must be met.

(5) In the provision of work or day services, the contractor must:

(a) provide any combination of work or day services, including supported work activities, according to the choices and needs of the individual and as specified by the IP team; and

(b) design activities, built on an array of options, that meet the needs and desires of the individual.

(6) A contractor for work or day services must ensure that medicaid home and community services monies are only expended on persons who are eligible for federally funded intensive adult services as provided in ARM 37.34.217.

(a) The person must have formerly resided in an ICF/MR or a nursing facility in order to be eligible for work services, including individual supported employment or paid work in any work or day service.

(b) The person who formerly resided in an ICF/MR or a nursing facility must not earn more than 50% of the minimum wage in a work activity center or sheltered workshop.

(2) A contractor providing supported living services must comply with the performance requirements in this rule. All performance requirements are to be met as provided in department rules and the contract with the department.

(3) A service placement designated as an independent living or transitional living placement as of June 30, 1995 or designated after June 30, 1995 as a supported living placement but specified by contract to be a not fully converted placement, is subject only to the requirements in (4) through (7) .

(4) Supported living services identify, provide, and coordinate necessary supports to maintain individuals in communities of their choice and create opportunities to have valued residential, vocational, and social opportunities. Supported living services make living arrangements available to individuals who are at least 18 years old and reside in neighborhood housing. The level and intensity of supervision, care, support, training, guidance and coordination of services and resources is based on individual needs, as determined by the IP team.

(5) Service options and funding sources may have specific requirements which must be met.

(6) In the provision of supported living services, the contractor must provide:

(a) identification of service needs including necessary resources and supports;

(b) identification, development, and access to existing resources and support networks;

(c) necessary current and future planning; and

(d) facilitation of personal choice, opportunities, and supports.

(7) In the provision of supported living services, the contractor must:

(a) provide supervision, support, care, training and guidance according to the needs of the individual as specified by the IP team;

(b) provide frequency of personal contact by staff with the individual as specified by the IP team;

(c) provide or encourage participation in a variety of integrated community activities;

(d) discuss and plan with the IP team, as appropriate for each individual, health and safety issues based on information gathered prior to the IP meeting including a risk assessment;

(e) recommend to the IP team a plan for each individual that will identify an emergency backup support and crisis response system to deal with problems or issues arising when support services are interrupted or delayed, or individual's needs change; and

(f) maintain the services for all supported living opportunities as described in the contract.

(8) Individuals and their representatives must have the opportunity to participate in the hiring of direct care staff assigned to work with them.

(9) There must be an individualized cost plan for each individual that includes a plan of care inclusive of supports which denote all support costs, administrative and support coordination costs.

(10) There must be portability of all or a portion of supported living funds to another qualified supported living provider as specified in the contract.

(11) There must be a consumer evaluation of supported living services conducted at least annually with a summary maintained.

(12) Supported living coordination must:

(a) teach the individual and caregivers to independently locate and establish contact with agencies who can assist them in securing the services they require. This allows them to become less reliant on the service system, generally, and supported living coordination, specifically;

(b) provide in-service training to those people providing habilitation, personal care, or other services to the recipient;

(c) manage personal and plan funding to ensure that personal and service needs are being met and that funds are efficiently utilized and accurately reported;

(d) provide for adequate supervision of the individual during the day, evening, and weekend;

(e) hire and supervise qualified staff to provide supported living services with input from the individual and caregivers;

(f) subcontract for services required by the plan of care;

(g) conduct periodic assessments of risk in order to ensure that the supported living arrangement is appropriate and safe given the individual's unique abilities and needs;

(h) conduct individual assessments specifically related to the supported living service. These assessments will not duplicate assessments completed by developmental disabilities case managers in scope or type of data collected;

(i) contract for suitable high quality housing, when necessary; and

(j) require documentation of the services provided and for approving payments to direct service providers.

(2) The contractor must document that the individual, with or without assistance, demonstrates the ability to respond to fire and other emergency procedures as specified in this rule, and as specified by the IP team. If the individual lives in the family home, the contractor must document that the individual, with or without assistance, demonstrates the ability to respond to fire and other emergency procedures agreed to by the family. These results must be shared with the IP team. If the individual lives in the family home the results must be shared with the family.

(3) The contractor, if it owns, leases or rents the residence or assists in locating the residence, must provide a safe and healthy living environment.

(4) The contractor must ensure that each residence meets the following life safety requirements:

(a) Smoke detectors must be present in each sleeping room and at a point centrally located in the area giving access to each separate sleeping area. A documented monthly check must occur to ensure that each detector is operating correctly.

(b) A fire extinguisher must be located in the kitchen. A documented annual check must occur to ensure that each extinguisher is operating correctly.

(c) Every room used for sleeping, living or dining must have at least 2 exits, at least 1 of which will be a door or stairway providing a means of unobstructed travel to the street or ground level outside of the building.

(d) All exits must be maintained in an unobstructed, easily traveled condition at all times.

(5) The contractor must develop and implement procedures for emergency evacuation to be followed in the case of fire or other emergency, and these emergency procedures shall include a plan for removing all persons, including individuals who need assistance in exiting.

(6) At least annually the contractor must demonstrate that the individual can evacuate safely with or without supervision.

(7) In any circumstances of a potentially unsafe or unhealthy living environment for an individual which the contractor does not own, lease or rent or which the contractor did not assist in locating, the contractor must in concert with the IP team:

(a) discuss and document with the individual and guardian the potentially unsafe or unhealthy concerns in the individual's residence;

(b) provide options to assist the individual in locating a safer and healthier residence; and

(c) ensure that the individual or guardian is making an informed decision to remain in a potentially unsafe or unhealthy residence.

(8) The contractor must maintain and implement procedures for:

(a) individualized, in-place emergency response systems. The individual must demonstrate the ability at least annually to use the system; and

(b) in-place systems for response during times when assigned staff do not report for duty.

(1) The department has been granted by the United States Department of Health and Human Services (HHS) the authority, through 42 USC 1396n(c) and 42 CFR 441.300 through 441.310, to provide Medicaid home and community-based services (HCBS) to persons with developmental disabilities. These rules implement in Montana the 0208 Medicaid Home and Community Services Waiver Program for persons with developmental disabilities.

(2) In accordance with the state and federal statutes and rules generally governing the provision of Medicaid-funded home and community-based services and the federal-state agreement specifically governing the provision of the Medicaid-funded home and community waiver services to be delivered through this program, and within the fiscal limitations of the funding appropriated and available for the program, the department may determine within its discretion the following features of the program:

(a) the types of services to be available;

(b) the amount, scope, and duration of the services;

(c) the target population;

(d) individual eligibility; and

(e) delivery approach.

(1) Services and selection into services through the 0208 Medicaid Home and Community Services Waiver Program are available only to the extent that the federal approval of the state's program permits and that available funding allows.

(2) The department, in order to comply with federal requirements or to limit expenditures to available funding, may:

(a) reduce the number of persons that may be served under the program;

(b) postpone or waive implementation of a particular service of the program; or

(c) eliminate one or more of the services of the program.

(1) A determination that a person is eligible to be considered for acceptance into the Medicaid Home and Community-Based Services (HCBS) Waiver Program does not entitle a person to selection and entry into the HCBS Waiver Program.

(2) A person is eligible to be considered for acceptance into the Medicaid HCBS Waiver Program if the person:

(a) is determined by the Developmental Disabilities Program (DDP) to be a person with a developmental disability in accordance with the criteria specified and approved in the waiver from the Centers for Medicare and Medicaid Services and in accordance with ARM Title 37, chapter 34, subchapter 2;

(b) applies for and meets the applicable Medicaid financial eligibility requirements found in ARM Title 37, chapter 82; and

(c) requires the level of care provided in an intermediate care facility for individuals with intellectual disability (ICF/IID), as determined by an evaluation of the person's service needs by the DDP.

(3) The level of care of an ICF/IID is needed when a person who is intellectually disabled:

(a) has severe medical problems requiring substantial care, but not to the extent that habilitation is impossible;

(b) has extreme deficits in self-care and daily living skills which require intensive training;

(c) has significant maladaptive social and/or interpersonal behavior patterns which require an on-going, supervised program of intervention; or

(d) has specialized service needs, and exhibits physical or mental limitations or changes similar to those expected in an older person.

(4) A person who has been admitted to an ICF/IID and who is discharged to enter services under the 0208 Medicaid HCBS Waiver Program for persons with developmental disabilities is considered to be of the level of care of an ICF/IID and need not be evaluated as provided in (2).

(5) For a person through the age of seven, the eligibility review panel (ERP) must make the determination of eligibility.

(6) The ERP must consist of the following members:

(a) a waiver-funded children's case manager;

(b) a provider's administrator or supervisor;

(c) a department's quality improvement specialist;

(d) a staff person who has had recent contact with the child, if applicable; and

(e) other members as determined by the panel, if applicable.

(7) The waiver-funded children's case manager must submit the following to the ERP for a determination of eligibility:

(a) a diagnostic statement from a physician; and

(b) any testing that reflects developmental delays; or

(c) a Vineland II (adaptive functioning assessment);

(d) a current psychological evaluation; and

(e) the eligibility determination form for children.

(8) For eligibility determinations made by the ERP, The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual does not apply to an eligibility determination for a child up to age seven.

(9) The ERP may determine a child is eligible if:

(a) the child has a diagnosis of a physical or mental condition that has a high probability of resulting in a developmental disability; or

(b) the child is experiencing developmental delays, with a 50% delay in one of the following areas or a 25% delay in two or more of the following areas:

(i) cognitive development;

(ii) physical developments, including vision and hearing;

(iii) speech and language development;

(iv) social and emotional development; or

(v) self-help skills.

(10) The department designee must annually administer a level of care re-determination.

(11) A child who has previously been determined eligible for services by the ERP must have a determination of eligibility by the department's eligibility specialist prior to the child's eighth birthday.

(12) For a person age eight and older, the department must make a determination of eligibility for consideration of acceptance into the 0208 HCBS Waiver Program.

(13) The department may make a determination of eligibility for acceptance into the 0208 HCBS Waiver Program as early as the age of six.

(14) The following documents must be submitted to the department's eligibility specialist to make a determination of eligibility for acceptance into the 0208 HCBS Waiver Program:

(a) a Vineland II;

(b) a current psychological evaluation, that for adults, is no more than ten years old; and

(c) page one of the eligibility determination form.

(15) The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual, as adopted in ARM 37.34.201, sets forth the requirements for eligibility of the DDP's service programs.

(16) Upon a determination of ineligibility, if the person is:

(a) on the waiting list, his or her name will be removed from the waiting list; or

(b) currently in waiver services, he or she will be exited from the 0208 HCBS Waiver Program ten days from the date of the notification letter.

(1) A person may be placed on the statewide waiting list for consideration for selection and entry into the 0208 Medicaid Home and Community-Based (HCBS) Waiver Program if the person is found eligible for the Developmental Disabilities Program (DDP) service in accordance with ARM 37.34.906.

(2) The DDP will enter the person's name onto the waiting list in chronological order based upon the date the case manager receives a complete request for services.

(3) The selection for consideration of persons with the same waiting list date will be made through a random selection process by the department.

(4) The DDP designee must notify a person selected for entry into the 0208 HCBS Waiver Program and the person's case manager in writing within ten working days of selection.

(5) Within five working days from the date of the notification letter the department designee must present all waiver service options available to the person selected and document which providers the person requests to meet and submit to the providers:

(a) the provider service referral packet;

(b) the plan of care; and

(c) other documents, as requested.

(6) A provider must contact the department designee within ten working days from the date the provider service referral packet was submitted to the provider and either:

(a) offer to serve the person; or

(b) decline to offer services.

(7) The person must determine which provider(s) he or she will accept services from within five days following the offer(s).

(8) The case manager must:

(a) document the person's choice of provider(s);

(b) obtain the person's or the person's legal representative's signature; and (c) maintain the documentation in the person's file.

(9) Upon acceptance of service(s), the person must begin service(s) within 45 working days from the date of the provider(s) offer to serve the person.

(10) The department may prioritize and select a person who has a life-threatening physical condition, is eligible for DDP services, and that without services would jeopardize their continued existence.

(11) The department reserves the right to select a person from the waiting list based upon emergency criteria if all other service options have been reviewed and do not meet the person's health and safety needs. The emergency criteria are as follows:

(a) a finding of maltreatment is determined by Child Protective Services or Adult Protective Services;

(b) death or inability of the person's primary caregiver to provide care and no alternative caregiver is available; or

(c) lack of appropriate placement for the person due to loss of housing or imminent discharge from the temporary placement or hospitalization.

(12) A person who is selected for entry into the 0208 HCBS Waiver Program and does not accept waiver services will be removed from the waiting list.

(13) If the person selected for entry into the 0208 HCBS Waiver Program cannot find a provider able or willing to provide services within 90 days from the date of the selection notification letter, the opening is forfeited.

(14) A person discharged from an ICF/IID located in the state of Montana who is eligible for home and community-based services in accordance with ARM 37.34.906 is not subject to the selection criteria and entry procedures otherwise stated in this rule. The department in its discretion may provide the person with a placement in the 0208 HCBS Waiver Program.

(1) "Agency with choice model" means an agency that is the legal entity under a contract with the Developmental Disabilities Program to administratively undertake legally necessary tax and labor law compliance responsibilities in relation to the delivery of services on behalf of a person receiving services who is authorized by the program to select and direct the staff who deliver those services. The person receiving services manages the scheduling, orienting, instructing, supervising, evaluating, and work records of the staff. The contracted agency is responsible for the following activities as they pertain to the person's staff:

(a) compiles records necessary for the reporting and payment of wages and benefits for the person's staff;

(b) calculates, withholds, and pays federal and state taxes;

(c) calculates and pays wages; and

(d) undertakes all other legally necessary activities.

(2) "Financial management service (FMS)" means the fiscal agent who assists the person conducting the business of self-direction. The fiscal agent educates the person, self-directing and acting as an employer, as to their responsibilities, processes employment paperwork, administers necessary preemployment screening, and processes employee timesheets. The fiscal agent must withhold and pay all employment related taxes and arranges for worker's compensation for all employees.

(3) "Person with employer authority using a fiscal management service" means the person or legal representative who is the legal employer and who is responsible for all aspects of hiring and managing staff and service documentation requirements.

(1) A person living in a natural home or private residence may elect to self-direct some or all of their waiver services using:

(a) an agency with choice model; or

(b) an employer authority using a financial management services (FMS) option.

(2) In order to elect a self-directed service option, the person must:

(a) receive Developmental Disabilities Program (DDP) Medicaid-funded waiver services; and

(b) live in their natural home or private residence in which the person's choice of services, support worker, and schedule for delivery of service has no adverse effect on other persons receiving waiver services.

(3) A person may opt out of self-directed services at any time and receive traditional agency-based services model.

(4) A person who chooses to disenroll from the self-directed service model must contact the case manager to schedule a planning meeting to determine the services he or she requires in the traditional agency-based services model.

(1) The following services may be provided under the Medicaid Home and Community-Based Services Program:

(a) adaptive equipment, as provided in ARM 37.34.925;

(b) adult companion, as provided in ARM 37.34.926;

(c) adult foster, as provided in ARM 37.34.929;

(d) assisted living, as provided in ARM 37.34.930;

(e) behavioral support, as provided in ARM 37.34.933;

(f) caregiver training and support, as provided in ARM 37.34.934;

(g) community transition, as provided in ARM 37.34.937;

(h) day supports and activities, as provided in ARM 37.34.938;

(i) environmental modifications, as provided in ARM 37.34.941;

(j) homemaker, as provided in ARM 37.34.942;

(k) individual goods and services, as provided in ARM 37.34.946;

(l) job discovery, as provided in ARM 37.34.947;

(m) job preparation, as provided in ARM 37.34.950;

(n) live-in caregiver, as provided in ARM 37.34.951;

(o) meals, as provided in ARM 37.34.954;

(p) nutritionist, as provided in ARM 37.34.955;

(q) occupational therapy, as provided in ARM 37.34.956;

(r) personal care, as provided in ARM 37.34.957;

(s) personal emergency response, as provided in ARM 37.34.960;

(t) personal supports, as provided in ARM 37.34.961;

(u) physical therapy, as provided in ARM 37.34.962;

(v) private duty nursing, as provided in ARM 37.34.963;

(w) psychological services, as provided in ARM 37.34.967;

(x) remote monitoring, as provided in ARM 37.34.968;

(y) remote monitoring equipment, as provided in ARM 37.34.971;

(z) residential habilitation, as provided in ARM 37.34.972;

(aa) residential training support, as provided in ARM 37.34.973;

(ab) respite, as provided in ARM 37.34.974;

(ac) retirement services, as provided in ARM 37.34.978;

(ad) speech therapy, as provided in ARM 37.34.979;

(ae) supported employment, follow along, as provided in ARM 37.34.980;

(af) supported employment, individual employment support, as provided in ARM 37.34.981;

(ag) supported employment, small group, as provided in ARM 37.34.985;

(ah) supported employment, coworker support, as provided in ARM 37.34.986;

(ai) supports brokerage, as provided in ARM 37.34.987;

(aj) transportation, as provided in ARM 37.34.988; and

(ak) waiver-funded children's case management, as provided in ARM 37.34.989.

(2) Services provided to a person through the 0208 HCBS Waiver Program are limited to the services specified in the person's individual plan of care and the individual cost plan.

(3) Services may be provided when required services exceed or are different from the services available in the Montana state plan.

(1) The criteria for a qualified provider to be authorized to deliver a service available through the 0208 HCBS Waiver Program are specified in the Provider Specifications for Services Matrix for the 0208 HCBS Waiver Program.

(2) The Provider Specifications for Services Matrix for the 0208 HCBS Waiver Program, dated December 27, 2013, sets forth the qualifications and standards that govern provider requirements in the provision of 0208 HCBS waiver services.

(3) The department adopts and incorporates by reference the Provider Specifications for Services Matrix for the 0208 HCBS Waiver Program, dated December 27, 2013.

(4) A copy of the matrix may be obtained through the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, PO Box 4210, Helena, MT 59604-4210 or at http://www.dphhs.mt.gov/dsd/ddp/medicaidwaivers.shtml.

(5) A provider must document the completion of training in the personnel file of the staff or in the provider's staff training file including:

(a) the date of the training;

(b) name and title of trainer;

(c) name and signature of person receiving the training;

(d) type of training;

(e) the agenda of the training; and

(f) hours of training.

(6) Any facility providing services must meet all applicable licensing requirements and fire and safety standards.

(7) A person directly providing services must be mentally and physically capable of assisting a person receiving services as required by the program.

(1) Reimbursement for the provision of services or items funded through the 0208 Medicaid Home and Community-Based Services Waiver Program is available in accordance with criteria and procedures in ARM 37.34.3001 and 37.34.3002.

(2) The rates of reimbursement for particular types of services and items that may be funded through the 0208 Medicaid Home and Community-Based Services Waiver Program are established in accordance with ARM 37.34.3005.

(1) The department may terminate a person's placement in the 0208 Medicaid Home and Community-Based Services Waiver Program if the person does not meet the requirements for the program, in accordance with this subchapter.

(2) The department may terminate a person's placement 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 efficient 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 poses imminent risk to the health and safety of the person or another person by not participating in the program services available to that person;

(g) behaviors of the person precluded 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.

(1) A person determined by the department to require the level of care provided in an ICF/IID must be given a choice between placement in an ICF/IID or in the 0208 Medicaid Home and Community-Based Services (HCBS) Waiver Program.

(2) The person or legal representative must be informed of the feasible alternatives in the community, if any, available under the 0208 Medicaid HCBS Waiver Program.

(3) The Quality Improvement Specialist will complete the Waiver 5, Freedom of Choice form with the person during the initial face-to-face level of care determination and document, in the person's file, that the person was given the choice and record the choice the person made.

(4) Case managers must inform the person currently served in the 0208 HCBS Waiver Program annually of feasible alternatives in the community and provide documentation for the person's file.

(1) A person aggrieved by an adverse determination by the department may request a fair hearing as provided in ARM Title 37, chapter 5, subchapter 3.

(1) Adaptive equipment is equipment necessary for the person to obtain or retain employment or to increase independent functioning in completing activities of daily living.

(2) Adaptive equipment must:

(a) relate specifically to and be primarily for the person’s disability;

(b) have utility primarily for a person who has a disability;

(c) meet the specifications, if applicable, for the equipment set by the American National Standards Institute (ANSI);

(d) be prior authorized by the department if the cost of the project may exceed $4,000; and

(e) be unavailable through any other sources.

(1) Adult companion services consist of nonmedical supervision and socialization provided to a person with a developmental disability. Companions may assist or supervise the person with tasks such as meal preparation, laundry, light housekeeping, and shopping but do not perform these activities as discrete services.

(2) Adult companion services must be provided in accordance with a therapeutic goal.

(3) Adult companion services may not be provided concurrent with:

(a) persons in residential settings in which primary care is funded 24/7; or

(b) with personal supports services.

(1) Adult foster support is a comprehensive service in which the person resides with an unrelated caregiver, licensed as an adult foster care provider, in order to receive support and supervision.

(2) A provider may provide service for up to four unrelated persons.

(3) Room and board, items of comfort or convenience, or the cost of the maintenance and improvement of the facility are not included.

(4) Adult foster support may not be provided concurrent with the following services:

(a) personal supports;

(b) live-in caregiver;

(c) homemaker; or

(d) personal care.

(5) A provider of adult foster services must be licensed in accordance with 50-5-101 through 50-5-216, MCA and ARM 37.100.101 through 37.100.175.

(6) A person may receive adult foster support independently or both adult foster support and residential training support.

(1) Assisted living is a congregate residential setting that provides or coordinates personal care, 24-hour supervision and assistance to meet the unpredictable needs of the person, activities, and health-related services.

(2) Assisted living is the provision of personal care, 24-hour supervision and assistance, and activities and health-related services.

(3) Room and board, items of comfort or convenience, or the cost of the maintenance and improvement of the facility are not included.

(4) Assisted living may not be provided concurrent with the following services:

(a) personal care;

(b) homemaker;

(c) residential habilitation;

(d) live-in caregiver;

(e) personal supports; and

(f) residential training supports.

(5) A provider of assisted living must be licensed according to the licensing requirements located in 50-5-101 and 50-5-225, MCA through 50-5-228, MCA, and ARM 37.106.2801 through 37.106.2908.

(1) Behavioral support services teach others to carry out ethical and effective behavior interventions based on positive behavior supports. Behavioral support services staff may supervise the work of others who implement behavior interventions.

(2) Behavioral support services may include:

(a) designing behavioral assessments and functional analysis of behavior;

(b) interpreting assessment and evaluation results for staff and unpaid caregivers;

(c) designing, monitoring, and modifying written behavior support intervention procedures;

(d) training staff and unpaid caregivers in the implementation of formal and informal behavioral support procedures; and

(e) attending planning meetings for the purpose of providing guidance and information to plan team members.

(3) A person providing behavioral support services must meet the requirements in ARM 37.34.1422(2).

(1) Caregiver training and support (CTS) are services for unpaid caregivers who provide training, companionship, or supervision to a person with a developmental disability in a family setting or a private noncongregate residence.

(2) Training for the caregiver may include:

(a) instruction about treatment regimens;

(b) use of specified equipment; and

(c) updates as necessary to safely maintain the person at home.

(3) Caregiver training and support (CTS) must be aimed at assisting the unpaid caregiver in meeting the needs of the person directly related to their role in supporting the person as identified in the plan of care.

(1) Community transition services are nonrecurring set-up expenses for a person who is transitioning from an institution to a Developmental Disabilities Program (DDP) waiver-funded home and community-based residential service.

(2) The community transition service must be necessary to enable a person to establish a basic household.

(3) Community transition services are furnished only to the extent that:

(a) they are reasonable and necessary;

(b) the person is unable to meet such an expense; or

(c) the services cannot be obtained from other sources.

(4) Community transition services may not include:

(a) monthly rental or mortgage expense;

(b) food;

(c) regular utility charges;

(d) household appliances; or

(e) items that are intended for purely recreational purposes.

(5) Community transition service is not available to a person transitioning into residential settings that are owned or leased by a Developmental Disabilities Program (DDP) funded service provider.

(6) The residential setting must be owned, leased, or rented by the person and must be considered the person's private residence.

(7) Community transition service may not exceed $3,000 per person, per transition.

(1) Day supports and activities consist of formalized habilitation services and staff support for the acquisition, retention, or improvement in self-help, behavioral, educational, socialization, and adaptive skills.

(2) Day supports and activities are person-centered, preplanned, purposeful, documented, and scheduled activities which take place during typical working hours, in a nonresidential setting, separate from the private residence of the person or other residential living arrangements.

(3) Day supports and activities may occur within a day activity setting, in the community, or in both settings.

(4) Day supports and activities may be provided as a continuous or intermittent service.

(5) Day supports and activities must consist of community inclusion activities.

(1) Environmental modifications are those physical adaptations to the home or vehicle which are necessary to safeguard the health, welfare, and safety of the person, or which enable the person to function with greater independence and without which the person would require institutionalization.

(2) An environmental modification must:

(a) relate specifically to and be primarily for a person with a disability;

(b) have utility primarily for a person who has a disability;

(c) not be an item or modification that a family would normally be expected to provide for a nondisabled family member;

(d) not be in the form of room and board or general maintenance;

(e) meet the specifications, if applicable, for the modification set by the American National Standards Institute (ANSI); and

(f) be prior authorized by the department if the cost of the project may exceed $4,000.

(1) Homemaker services are general household activities performed when the person regularly responsible for these activities is unable to manage the home or care for self or others in the home or is engaged in providing habilitation and support services to the person with the developmental disability.

(2) Homemaker services may include meal preparation, cleaning, simple household repairs, laundry, shopping for food and supplies, and other routine household care.

(3) Homemaker services do not include the provision of personal care services as described in ARM 37.34.957.

(1) Individual goods and services are services, supports, or goods that enhance opportunities to achieve outcomes related to living arrangements, relationships, and inclusion in the community as identified and documented in the plan of care.

(2) Individual goods and services must fall into one of the following categories:

(a) memberships and fees; or

(b) equipment and supplies.

(3) Individual goods and services must be:

(a) exclusively for the benefit of the person; and

(b) the most cost-effective alternative that reasonably meets the assessed need of the person.

(4) The service, equipment, or supply must meet the person's medical needs or provide support in order to be independent in daily activities and must meet one of the following criteria:

(a) promotes inclusion in the community;

(b) increases the person's safety in the home environment; or

(c) decreases the need for other Medicaid services.

(5) The cost of the service, equipment, or supply must not compromise the person's health or safety by depleting their individual cost plan to the extent they cannot receive services that provide for their health and safety.

(6) Service, equipment, or supplies which are experimental will not be reimbursed.

(7) A person or the person's delegate self-directing services with employer authority using the financial management service (FMS) option must purchase goods and services in accordance with the requirements set forth by the Developmental Disabilities Program (DDP) and receive reimbursement from the fiscal management service.

(8) Individual goods and services expected to exceed a $2,000 annual aggregate limit require prior approval by the DDP regional manager.

(1) Job discovery is individual assistance to identify supports and develop employment goals and a career profile or career plan for achieving integrated employment. Career profiles or career plans may be developed through various strategies such as job exploration, job shadowing, informational interviewing, job and task analysis activities, employment preparation, business plan development for self-employment, and volunteerism.

(2) Job discovery is limited to 40 hours of service per year, unless additional hours are prior approved by the Developmental Disabilities Program (DDP).

(3) Job discovery may be provided in conjunction with other employment services.

(4) Agency-based services may be provided in:

(a) a community setting; or

(b) a developmental disability legal entity site.

(5) Job discovery must be provided in a community setting with 1:1 staff ratio.

(1) Job preparation provides formalized training and work experiences, based upon the goals identified during job discovery, intended to teach a person the skills necessary to succeed in a paid competitive, customized, or self-employment setting. Training may also address workplace social skills and the development of practices and behaviors necessary for successful employment.

(2) Job preparation must be primarily for the purpose of habilitation.

(3) If the person has not obtained integrated employment after two years of receiving job preparation, the job discovery process must be repeated.

(4) Job preparation may be provided in conjunction with other employment services.

(1) Live-in caregiver services provide support to enable a person to live independently and participate in community activities to the fullest extent possible. The live-in caregiver assists with implementing the needed supports as identified in the plan of care which enable the person to retain or improve skills related to health, activities of daily living, money management, community resources, community safety, and other adaptive skills needed to live in the community.

(2) Live-in caregiver services cannot be provided in the caregiver's private residence or in a residence that is owned or leased by a Montana Medicaid provider.

(3) Live-in caregiver services must include an approved back-up plan in the event of service disruption.

(4) Terms and conditions of the service must be specified in a written live-in caregiver agreement between the legal entity, the live-in caregiver, and the person receiving the service and approved by the department.

(5) Parents or legal representatives may not be reimbursed for live-in caregiver services.

(6) Live-in caregiver services are reimbursed a daily room and board stipend.

(7) The annual cap for live-in caregiver services is $9,000.

(1) Meal services provide hot or other appropriate meals once or twice a day, up to seven days a week, to ensure that a person receives adequate nourishment and to prevent institutional placement.

(2) Meal services may only be provided to a person who is not eligible to receive meals from any other source, or who need different or more extensive services than are otherwise available.

(1) Nutritionist services are services related to the management of a person's nutritional needs and include:

(a) meal planning;

(b) consultation with and training for persons providing direct care; and

(c) education for the person receiving the service.

(2) Nutritionist services do not include the provision of meals.

(3) Nutritionists must meet the licensing requirements in Title 37, chapter 25, part 3, MCA.

(1) Occupational therapy is as defined in 37-24-103(5), MCA.

(2) Providers of occupational therapy services must be licensed in accordance with the rules and regulations governing the profession.

(3) Occupational therapy must be provided through direct contact with a licensed therapist and the person or to train persons working directly with the person receiving the service.

(4) Occupational therapists may provide evaluation, consultation, training, and treatment.

(5) Occupational therapy may be provided when required occupational therapy services exceed Montana state plan or are different from the services available in the Montana state plan.

(1) Personal care services provide medically necessary in-home services to persons who are functionally limited in performing activities of daily living.

(2) Personal care services may include:

(a) assistance with personal hygiene, dressing, eating, and ambulatory needs;

(b) household tasks incidental to the health care needs of the person or otherwise necessary to maintain the person in the home; and

(c) supervision for health and safety reasons.

(3) Personal care services may be provided when the required personal care services exceed the Montana state plan or are different from the services available in the Montana state plan.

(1) Personal emergency response system (PERS) is an electronic device that enables the person to secure help in an emergency. The system is connected to the person's phone and programmed to signal a response center once a help button is activated. The response center is staffed by trained professionals. PERS services may be appropriate for persons who live alone, or who are alone for parts of the day, and have no regular caregiver for periods of time.

(2) PERS service may be delivered via a cellular phone.

(3) To access the cellular phone option, the person must:

(a) require access to assistance or supports; and

(b) frequently be beyond the range of coverage of a PERS system.

(4) Cell phone plans must be basic plans and must not include features or applications unrelated to health and safety issues.

(5) A usage control feature and insurance may be added to the basic plan.

(6) The person must pay any overage fee and any other fees that are not approved in the plan of care.

(7) The case manager must review the cell phone guidelines with the person upon receipt of the phone and at the annual planning meeting.

(1) Personal supports service assist the person in carrying out daily living tasks and other activities essential for living in the community and provide supervision and monitoring to ensure the person's health and safety.

(2) Personal supports may assist the person with:

(a) ensuring the person's health and safety;

(b) accessing the community;

(c) development of self-advocacy skills;

(d) identifying and sustaining a personal support network;

(e) household activities necessary to maintain the home-living environment;

(f) home maintenance activities;

(g) maintaining employment; and

(h) accessing opportunities.

(3) Personal supports may only be provided to a person self-directing services.

(4) Waiver services which overlap with the activities of personal supports may not be provided concurrently with personal supports including:

(a) live-in caregiver;

(b) adult companion;

(c) extended personal care services; and

(d) homemaker services.

(1) Physical therapy is as defined in 37-11-101(7), MCA.

(2) Providers of physical therapy services must be licensed in accordance with the rules and regulations governing the profession.

(3) Physical therapy must be provided through direct contact with the therapist and the person or to train persons working directly with the person receiving the service.

(4) Physical therapist may provide supports that:

(a) improve or preserve abilities of independent functioning; and

(b) prevent, in as much as possible, chronic or progressive conditions.

(5) Physical therapy may be provided when required physical therapy services exceed the Montana state plan or are different from the services available in the Montana state plan.

(1) Nursing services are defined in 37-18-102, MCA.

(2) Providers of nursing services must be licensed in accordance with the rules and regulations governing the profession.

(3) A person receiving the private duty nursing must be 21 years of age or older.

(4) Private duty nursing may be provided when the required nursing services exceed the Montana state plan or are different from the services available in the Montana state plan.

(5) Private duty nursing must be provided in the location where the person needs the service.

(1) Psychological and counseling services are those services provided by a licensed psychologist, licensed professional counselor, or a licensed clinical social worker within the scope of the practice of the respective professions.

(2) Service definitions for each profession may be found at the following:

(a) licensed psychologist, 37-17-102(4), MCA;

(b) licensed professional counselor, 37-23-102(3), MCA; and

(c) licensed clinical social worker, 37-22-102(5), MCA.

(3) Psychological and counseling services may include:

(a) individual or group therapy;

(b) consultation with providers and caregivers;

(c) development and monitoring of behavior programs;

(d) participation in the individual planning process; and

(e) counseling for primary caregivers.

(4) Psychological and counseling services are available to adults when the service is:

(a) recommended by a qualified professional;

(b) approved by the planning team; and

(c) written into the plan of care.

(5) Psychological and counseling services may be provided when the required nursing services exceed the Montana state plan or are different from the services available in the Montana state plan.

(1) Remote monitoring provides oversight and monitoring within a residential setting through off-site electronic surveillance, while maintaining the health and safety of the person receiving the service.

(2) Remote monitoring must be done in real time, by awake staff, at a monitoring base using:

(a) live video feed;

(b) motion sensing systems;

(c) radio frequency identification;

(d) web-based monitoring systems; or

(e) other devices approved by the Developmental Disabilities Program (DDP).

(3) The person receiving remote monitoring must be 18 years of age or older.

(4) The remote monitoring staff must not participate in other duties while providing remote monitoring.

(5) The provider must have an effective emergency notification system in place to respond to any emergency within a reasonable time. The emergency response system must be written in the plan of care and must include:

(a) the circumstances in which backup supports must be contacted;

(b) the expected timeframes in which backup supports must respond; and

(c) if the response must be in person or by other means of contact, including notification to emergency responders such as police, fire, and medical services.

(6) Live two-way communication may be provided if it is designated in a person's plan of care.

(7) The case manager must fully inform the person or their legal representative and each person who resides with the person of what remote monitoring entails and obtain written consent from each person. The case manager must keep the written consent with the person's plan of care.

(8) Remote monitoring may only be used in supported living settings with the purpose of:

(a) reducing or replacing the amount of residential habilitation needed by the person; or

(b) preventing the need for additional residential habilitation.

(9) Remote monitoring providers must have a backup power supply in place at the monitoring base in the event of an electrical outage.

(10) Service documentation must fully disclose the nature and extent of the services delivered and be signed by the person delivering the service.

(11) The provider of remote monitoring must disclose the current ratio of monitoring staff to persons receiving remote monitoring to the person's plan of care team during the provider selection process and update the information annually and as changes occur.

(1) Remote monitoring equipment is the equipment used to operate systems such as live feed video, live audio feed, motion sensing system, radio frequency identification, web-based monitoring system, or other devices approved by the Developmental Disabilities Program (DDP). It also refers to the equipment used to engage in live two-way communication with the person being monitored.

(2) Remote monitoring equipment must include an indicator to the person being monitored that the equipment is on and operating. The indicator must be appropriate to meet the person's needs.

(3) Remote monitoring equipment must be designed to be turned off only by the person indicated in the plan of care.

(4) The provider of remote monitoring equipment must be responsible for the following:

(a) delivery of equipment to the person's residence and as needed to the room or area of the residence in which the equipment will be used;

(b) assembly and installation of the equipment, as appropriate for correct operation;

(c) adjustment and modification to the equipment, as needed;

(d) conduct monthly testing of the equipment to ensure proper operation;

(e) maintain and repair equipment, as necessary; and

(f) replace equipment at any time for any reason other than misuse or damage by the person receiving the service.

(1) Residential habilitation services support persons in acquiring, retaining, and improving self-help, social, and adaptive skills necessary to reside successfully in home and community-based settings.

(2) The service includes caregiving, skills training, and supervision to a person in a noninstitutional setting. The degree and type of care, supervision, and skills training is based on the person's needs and must be identified in the plan of care.

(3) Training may be provided in basic self-help, home and community living, and leisure and social skills.

(4) Each training objective must be specified in the plan of care and related to the long-term goals of the person.

(5) Residential habilitation must be provided where the person lives. Settings include:

(a) group homes;

(b) congregate and noncongregate living apartments; and

(c) natural homes.

(1) Residential training support provides training to increase the person's independence in health care, self-care, safety, and access to community services.

(2) Residential training supports are available to a person receiving adult foster support service in accordance with assessed needs and as identified by the person in the plan of care.

(3) Residential training supports may only be provided when delivered in a licensed adult foster home funded under adult foster supports.

(4) If the provider of the adult foster support service is not qualified to provide residential training supports, the service must be made available by a qualified employee of an agency under contract with the Developmental Disabilities Program (DDP).

(1) Respite care is relief services designed to allow family members, who regularly care for the person receiving waiver services, to be relieved from their caregiver responsibilities in relation to reducing stress generated by the provision of constant care to the person receiving waiver services.

(2) Respite providers must be selected and trained by the parents or legal representatives of the person.

(3) Respite care may be provided in:

(a) a licensed children's day care center and in a licensed family and group day care home for children from birth through age 12;

(b) a licensed children's day care center and in a licensed family and group day care home for children age 13 through age 17; and

(c) a licensed adult day center for a person 18 and older.

(4) The waiver will pay the difference in cost between usual and customary rates and the increased rate charged by the provider, as described in (3), to serve a child with extraordinary support needs for children under the age of 13.

(1) Retirement services are available to a person who is age 62 or older, or who is limited due to health and safety issues. Retirement services are structured services consisting of day activities and residential support. Retirement services are furnished in a way which fosters the independence of each person. Retirement services are person-centered and person-directed to the maximum extent possible.

(2) Retirement services may be provided as a continuous or intermittent service.

(3) Retirement services must be provided in a residential or community day activity setting.

(4) The expected outcome of retirement services is to:

(a) maintain skills and abilities to the maximum extent possible;

(b) keep the person engaged in their environment and community; and

(c) provide supervision, safety, and security.

(5) In a provider-operated residence, only shared living spaces such as the living room, kitchen, bathroom, and recreational areas may be utilized to provide retirement services.

(1) Speech therapy is as defined in 37-15-102, MCA.

(2) Providers of speech therapy services must be licensed in accordance with the rules and regulations governing the profession.

(3) Speech therapy must be provided through direct contact with the therapist and the person or to train persons working directly with the person receiving the service.

(4) A speech therapist may provide:

(a) screening and evaluation with respect to speech and hearing functions;

(b) comprehensive speech and language evaluations when the screening indicates it is necessary;

(c) continuing interdisciplinary evaluation for the purpose of beginning, monitoring, and following up in regards to habilitation programs; and

(d) treatment services designed to develop specialized programs for communication.

(5) Speech therapy may be provided when required speech therapy services exceed the Montana state plan or are different from the services available in the Montana state plan.

(1) Follow along support consists of habilitation services and supports that enable a person to stabilize or expand employment in a competitive, customized, or self-employment setting.

(2) The person may require follow along support when:

(a) the person's job is in jeopardy; or

(b) a job promotion opportunity requires more complex, comprehensive, or intensive supports.

(3) Follow along support may be provided in an extended ongoing manner or intermittently as needed.

(4) Follow along support may include:

(a) person-centered employment planning;

(b) job promotion activities;

(c) observation and job support to enhance job task skills;

(d) monitoring at the work site to ascertain the success of the job placement;

(e) job coaching;

(f) follow up with the employer, coworkers, employed person, parents, legal representatives, and others as needed, in order to reinforce and stabilize job placement;

(g) facilitation of natural supports at the work site;

(h) advocating for the person at the employment site;

(i) assistance with management of financial paperwork;

(j) assistance with medication administration considered incidental to the follow along support;

(k) application of behavioral intervention programs, when developed and approved according to the positive behavioral support rule.

(5) Follow along support may be provided in conjunction with other employment services.

(1) Individual employment supports are habilitation services and staff supports needed by a person to acquire integrated employment or career advancement in the general workforce. Individual employment support is delivered in a competitive, customized, or self-employment setting. The outcome of this service is paid employment in a competitive, customized, or self-employment setting within the general workforce that meets the person's personal and career goals, as documented in the plan of care.

(2) Individual employment supports may include:

(a) person-centered employment planning;

(b) job development;

(c) negotiation with prospective employers;

(d) creating a job description based on a task derived from a single traditional job (job carving);

(e) job placement;

(f) support for career advancement opportunities;

(g) job analysis;

(h) training, support, coordination, and communication in related skills needed to obtain or retain employment;

(i) job coaching;

(j) job loss support; and

(k) benefit planning support.

(3) Individual employment supports may be provided in conjunction with other employment services.

(1) Small group employment support consists of habilitation services and staff supports needed for groups of two to eight workers with disabilities to acquire and maintain a job or position in the general workforce.

(2) Small group employment support must be provided in a manner that promotes integration into the workplace and interaction between people with and without disabilities in those workplaces.

(3) Small group employment support must occur in business settings during the hours typical for the industry.

(4) Small group employment support may include:

(a) person-centered employment planning;

(b) job development;

(c) negotiation with prospective employers;

(d) creating a job description based on a task derived from a single traditional job (job carving);

(e) job placement;

(f) support for career advancement opportunities;

(g) job analysis;

(h) training, support, coordination, and communication in related skills needed to obtain or retain employment;

(i) job coaching; and

(j) benefit planning support.

(5) Small group employment support may be provided in conjunction with other employment services.

(1) Coworker support service allows the Developmental Disabilities Program (DDP) and developmental disabilities provider agencies to contract with a business to provide coworker job supports as a part of the natural workplace. This service differs from supported employment, follow along support in that it creates opportunity for services and supports to be provided by the employee of a local business where the person is employed. This service is intended to provide ongoing coworker support allowing follow along support to be decreased.

(2) The purpose of supported employment coworker support is to assist the person to:

(a) develop positive work-related habits, attitudes, and skills;

(b) acquire work etiquette directly related to their specific employment;

(c) gain knowledge of the health and safety aspects/requirements of their particular job;

(d) assist the person in becoming a part of the informal culture of the workplace;

(e) provide job skill maintenance or assistance with incorporating new tasks; and

(f) facilitate other supports at the work site.

(3) Coworker support may be provided in conjunction with other employment services.

(4) The employer is reimbursed a daily rate to offset the cost to the employer for providing the supports which may be needed to maintain the person in the job.

(1) Supports brokerage services assist the person self-directing service with employer authority in arranging, directing, and managing self-directed services as described in the person's plan of care. The supports broker acts as an agent of the person or legal representative and is available to assist in identifying immediate and long-term needs, developing options to meet those needs, and accessing identified supports and services.

(2) As determined by the scope and nature of the opportunities afforded to the person in waiver services, supports brokers may provide information regarding the following:

(a) person-centered planning and how it is applied;

(b) the range and scope of the choices and options the person has;

(c) the process for changing the plan of care and the individual budget;

(d) the grievance process;

(e) risks and responsibilities of self-direction;

(f) freedom of choice of providers;

(g) reassessment and review of schedules; and

(h) other information pertinent to managing self-directed services.

(3) The supports broker may assist the person with:

(a) defining goals, needs, and preferences;

(b) training the person on the material contained in the self-directed employer handbook;

(c) day-to-day management of the budget for self-directed services;

(d) identifying and accessing services, support, and resources;

(e) practical skills training regarding hiring, managing, and terminating employees;

(f) problem solving and conflict resolution;

(g) development of risk management agreements;

(h) development of an emergency backup plan;

(i) exercising independent advocacy;

(j) completing required forms; and

(k) development and maintenance of service documentation.

(4) Duplicative services are not allowed concurrent with supports brokerage. In instances where activities of the supports broker duplicate the provisions of case management, the plan of care must clearly delineate the responsibilities for performance activities.

(5) The annual cap for supports brokerage is the lesser of $6,000 or 20% of the value of the individual cost plan (ICP). These values may be exceeded for a limited time period in extraordinary circumstances with prior approval of the Developmental Disabilities Program (DDP) director.

(1) Transportation services are those services which enable persons served in the waiver to gain access to waiver and other community services, activities, and resources.

(2) Transportation may be offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the state plan, defined at 42 CFR 440.170(a).

(3) Reimbursable transportation expenses may include assistance with reasonable costs related to one or more of the following areas, as determined by the Developmental Disabilities Program (DDP):

(a) operator training and licensure;

(b) insurance; and

(c) registration or other costs associated with a person's dependence on the use of a personal vehicle as outlined in the plan of care.

(4) The following are excluded from transportation services:

(a) adaptations or improvements to the vehicle that are of general utility, and are not of direct medical or remedial benefit to the person;

(b) purchase or lease of a vehicle;

(c) regularly scheduled upkeep and maintenance of a vehicle with the exception of upkeep and maintenance of any modifications; and

(d) escort services.

(5) For self-directed services, the financial management service (FMS) may only pay mileage reimbursement upon receiving documentation that transportation was provided in accordance with Montana state requirements for operating a motor vehicle.

(6) Mileage reimbursement through the FMS may be available to the owner of the vehicle when:

(a) transportation services to the person are for approved community functions;

(b) all the requirements for operating a motor vehicle that are required have been met; and

(c) the mileage reimbursement provision is approved in the plan of care.

(7) A person with employer authority using the FMS option may only be reimbursed for mileage.

(8) Transportation may be provided when required transportation services exceed the Montana state plan or are different from the services available in the Montana state plan.

(9) Legal representatives and other persons who are not employees of agencies with a Developmental Disabilities Program (DDP) contract may be reimbursed for the provision of rides at the mileage rate based on the operational expense of a motor vehicle but does not include:

(a) reimbursement for work performed;

(b) the driver's time; or

(c) transportation not directly related to the specific disability needs of a person, as outlined in the plan of care.

(10) A person providing transportation services must:

(a) be 18 years of age or older;

(b) have a valid motor vehicle license;

(c) maintain liability insurance; and

(d) have proof of vehicle registration.

(1) Waiver-funded children's case management (WCCM) services are services furnished to assist a person in gaining access to needed medical, social, educational, and other services. WCCM includes the following assistance:

(a) comprehensive initial assessment and periodic reassessment to determine a child's need for any medical, educational, social, or other services;

(b) development and periodic revision of a specific care plan;

(c) referral and related activities to help an eligible child to obtain needed services;

(d) monitoring and follow-up activities including activities and contacts that are necessary to ensure the plan of care is implemented and adequately addresses the child's needs;

(e) completion of the freedom of choice form; and

(f) assistance with crisis intervention planning to locate suitable alternative placement when the person's health or safety is at risk.

(2) WCCM may not provide:

(a) case management activities that are a component of another covered Medicaid service;

(b) direct delivery of medical, educational, social, or other services the person has been referred to; or

(c) administration of foster care programs or other nonmedical programs.

(3) A person providing WCCM must:

(a) possess a bachelor's degree in social work or a related field from an accredited college and have one year of experience in human services, or have provided case management services, comparable in scope and responsibility to that provided by targeted case managers, to persons with developmental disabilities for at least five years;

(b) have at least one year's experience in the field of developmental disabilities or, if lacking such experience, complete at least 40 hours of training in the delivery of services to persons with developmental disabilities under a training plan reviewed by the Developmental Disabilities Program (DDP) within three months of hire or designation as a case manager;

(c) participate in a minimum of 20 hours of training in services to persons with developmental disabilities each year, including abuse prevention training provided by the DDP under a training plan reviewed by the DDP; and

(d) case managers who have not been certified must participate in the first MONA (the Montana resource allocation protocol tool) or mini MONA certification training opportunity available after hire.

(4) A staff person providing case management to youth age 16 through 21 must be certified to complete the personal support plan.

(5) Documentation of the qualifications of a case manager and completion of mandated training must be maintained by the employer.

(1) A personal support plan (PSP) identifies the supports and services that are necessary for a person receiving state-administered developmental disabilities services to achieve independence, dignity and personal fulfillment. The PSP is a person-driven and person-centered plan that assesses an eligible person's needs and identifies services that are appropriate to meet the person's assessed needs.

(1) An initial personal support plan (PSP) must be developed by the PSP team with the participation of the person within 30 calendar days of the person's entry into a service program or when the person moves from services in one community to services in another community. The PSP may be reviewed within 60 days of adoption if needed to accurately reflect the person's needs for support and services. The PSP must be reviewed annually by the PSP team and updated to accurately reflect the person's needs for support and services.

(2) The person's case manager must schedule and facilitate all PSP meetings. The case manager:

(a) sends written notice to the person and the person's legal representative at least 14 days prior to the PSP meeting;

(b) meets with the person or the person and the PSP team prior to the PSP meeting to develop the person's vision statements; and

(c) posts the completed PSP on the department-approved data management system within 21 calendar days of the PSP meeting and provides a copy, if requested, to PSP team members who do not have access to the data management system.

(3) Providers must submit the assessments required by ARM 37.34.1105 with summaries to the case manager at least 14 calendar days prior to the PSP meeting and submit action plans no later than 14 calendar days after the PSP meeting.

(4) The day after the PSP meeting is the effective date of the PSP.

(5) The PSP team must conduct an annual PSP meeting with the person within the same month as the person's last annual PSP meeting.

(6) Each provider will revise the lifestyle and wellness, general information, and financial page in the PSP if the needs of the person necessitate a revision.

(7) Any member of the PSP team may request a review, or a revision, or both a review and revision to the PSP, as determined by the person's needs.

(1) Each personal support plan (PSP) must include the following:

(a) Vision statements that describe where the person wants to live or work, what the person would like to learn, what social opportunities the person would like to be involved in, and what interests the person would like to pursue. Vision statements are written for a one to three year span of time.

(b) Outcome statements that define what the person wants to accomplish, written in the person's own words when possible, and directly relate to the person's vision statements.

(c) Action statements that define how the person will achieve the outcomes described in (b).

(2) A PSP may include an action plan developed by the provider responsible for completing the specific action. If an action plan is required, the provider must:

(a) develop the action plan in accordance with department policy;

(b) describe the training and support the person needs to achieve the action statements required in (1)(c); and

(c) provide the action plan to the case manager within 14 days after the PSP meeting.

(3) A PSP must include an action plan developed by the provider when the person has the following needs:

(a) self-administration of medication;

(b) supported employment;

(c) rights restrictions; or

(d) positive behavior supports approved according to ARM Title 37, chapter 34, subchapter 14.

(1) The case manager must complete the following annual assessments for the purpose of personal support planning:

(a) a consumer survey to be completed upon the person's entry into services and annually thereafter; and

(b) a risk factor for health and safety form.

(2) The residential provider agency must supply the following assessments, if applicable:

(a) physical: yearly, unless otherwise recommended by the person's physician;

(b) dental: yearly, unless otherwise recommended by the person's dentist;

(c) hearing: as determined by the person's health care professional; and

(d) vision: as determined by the person's health care professional.

(3) Providers must address the following assessment domains:

(a) living;

(b) employment;

(c) educational;

(d) developmental; and

(e) social.

(4) If the person with a developmental disability is not receiving residential services by a provider agency, the case manager must obtain the assessments in (2).

(1) The personal support plan (PSP) team must include the following persons:

(a) the person with a developmental disability, if able to participate;

(b) the advocate of the person, if applicable;

(c) the legal representative of the person, if applicable;

(d) the PSP certified case manager of the person;

(e) a staff person from each service program; and

(f) other person(s) who are approved by the person.

(2) If the person or a legal representative is unable to participate in the PSP meeting, the case manager must document the reasons for the absence and subsequently submit the plan of care to the person or legal representative for their review. The person or their legal representative may request that the team meet to consider any objections that they may have.

(1) Providers must complete a quarterly report for each action statement. The report must include:

(a) a brief summary of progress toward the attainment of the action statements listed in the personal support plan (PSP); and

(b) a brief summary of any action taken to assure progress.

(2) Providers must submit quarterly reports:

(a) every three months after the actual date of the initial PSP meeting; or

(b) before the 30th day of January, April, July, and October, if the provider is on a calendar year schedule.

(3) Providers must prepare the quarterly report on the fourth quarter for review at the annual PSP meeting.

(4) Providers must prepare and submit the quarterly report in the data management system approved by the department.

This rule has been repealed.

(1) The personal support plan (PSP) team must base all decisions on a team process which is person-driven and person-centered and ensures the health and safety of the person receiving services. The PSP team members must consider the:

(a) the person's rights;

(b) person's needs, visions, and preferences;

(c) person's health and safety needs;

(d) Montana resources allocation (MONA) for the person; and

(e) person's cost plan (ICP).

(2) All decisions of the PSP team must be made in consensus.

(3) If consensus cannot be reached, the person(s) who does not consent may submit their disagreement along with the justification for their disagreement within five working days to the regional manager. The regional manager must:

(a) make a determination within five working days; and

(b) provide the determination in writing to the members of the PSP team.

(4) The person receiving service maintains the right to request an administrative fair hearing.

This rule has been repealed.

(1) An individual family service plan (IFSP) must be adopted for children through 15 years of age who are receiving federally authorized Part C early intervention or Medicaid funded services. An IFSP is a written plan which denotes supports for a child and a child's family as identified through multidimensional and multidisciplinary assessment and information gathering. The IFSP serves as an agreement between the family with an eligible child, agencies, and other service providers.

(1) The individual family services plan (IFSP) must be developed in accordance with the Part C early intervention federal regulations at 34 CFR 303.340 through 303.345.

(2) The department will establish policies and procedures for the development and implementation of the IFSP that are in compliance with governing federal laws and regulations.

(3) The department hereby adopts and incorporates by reference the federal regulations at 34 CFR 303.340 through 303.345. 34 CFR 303.340 through 303.345 contain the requirements under which an IFSP must be developed, reviewed, and implemented. A copy of the cited requirements is available from the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604.

(2) An adult or family services contractor in providing education and training must comply with the performance requirements in this rule.

(3) Education and training must be directed toward the individual's attainment of goals identified by the IP or the IFSP team.

(4) There are 2 categories of training: formal and incidental. Formal training is a focused, documented effort to accomplish a training objective. Incidental training occurs incidental to daily living and is facilitated through various techniques which recognize that all individuals learn, grow and develop if given the opportunity to do so. Formal training should occur in the environment in which the knowledge, skill or ability will most likely be used.

(5) Training may be most appropriate across a variety of environments. The IP or the IFSP team identifies the settings for specific training objectives. The training method should be the most culturally normative, effective method for the individual and the skill or ability that is the subject of the training. Incidental training should occur across all settings.

(6) Training, formal or incidental, must be provided in the development of one or more of the following areas: motor/physical, communication, self-help and personal care, functional academics, community life, social and sexual, health and safety, home-related skills, adaptive behavior, leisure, work, job-specific training, and self-advocacy.

(7) Motor and physical training develops gross and fine motor skills. Training includes locomotion, body posture and control, motor coordination and physical conditioning.

(8) Communication training develops an individual's ability to affect the environment around them through other people. Training includes receptive and expressive language and control of inappropriate verbalization.

(9) Self-help and personal care training develops independence in basic daily living skills. Training includes eating, toileting, dressing, bathing, hair care, personal hygiene and grooming; clothing selection and care; care of menstrual needs; mobility and care of mobility devices.

(10) Functional academics develops academic skills directly related to independent functioning in the community. Training includes reading and survival word recognition and number concepts and recognition.

(11) Community life training develops independence in the community, locating and using community resources, and interacting with others. Training includes orientation to the community, travel and transportation; community recreation; safety, including traffic signs; shopping skills, restaurant use and use of community services.

(12) Social and sexual training develops independence and acceptance in the community. Training includes interpersonal relationships, birth control, marriage, children and pregnancy; sexual abuse and exploitation; alcohol and drug use; human development; and disease and sexually transmitted disease prevention.

(13) Health and safety training develops the skills necessary to live independently and safely in the community and to maintain optimal health. Training includes self administration of medications; first aid; nutrition; home, work and community safety and response to emergencies.

(14) Home-related skills training develops independence in managing one's own home. Training includes financial management; clothing care and selection; household chores, meal preparation and food handling; home repair and maintenance; time telling; telephone usage; and use and care of major appliances.

(15) Adaptive behavior training develops acceptable alternatives to maladaptive behavior. Training includes positive programming, dealing with difficult situations, anger management, independence, dependability, initiative, versatility and decreasing maladaptive behavior.

(16) Leisure training develops independent, age-appropriate use of free time, both through individual and group activities. Training includes crafts; individual and group games; hobbies and sports.

(17) Work training develops skills which are necessary to functioning in the work environment. Training includes small assembly; color and shape assembly; attention span/attending and following instructions; matching and sorting and simple assembly; quality of work, quantity of work and general work habits; obtaining employment, relating to supervisor and relating to peers.

(18) Job-specific training develops all the skills necessary to succeed in the paid employment that an individual is hired to perform.

(a) Training occurs within the actual job environment and addresses naturally occurring demands and contingencies.

(b) The trainer assists the employee in completing the job until all the tasks can be performed at the standards established by the employer.

(c) Trainer activities may include, but are not limited to performing the job in order to prepare a task analysis; identifying and addressing employee needs; directly training employees within the natural environment and ensuring completion of job requirements for the employer until the employee is completing the job independently.

(19) Self advocacy training develops advocacy skills. Training includes rights, responsibilities and participation in the planning process.

(2) A contractor providing adult or family services in the provision of leisure and community activities must comply with the performance requirements in this rule.

(3) The individual must be allowed the opportunity to choose community activities to participate in. The individual may choose the activities based on the individual's knowledge of the variety of activities occurring within the community.

(a) The individual should be encouraged and assisted in experiencing a variety of enjoyable community activities.

(4) The individual must be allowed the opportunity to choose leisure activities to participate in. The individual may choose the activities based on the individual's knowledge of the variety of activities occurring within the individual's services and the community.

(a) The individual should be encouraged and assisted in experiencing a variety of enjoyable leisure activities.

(b) A variety of leisure activities should be available, based on the preferences of the persons receiving services.

(1) The purpose of the rules under this subchapter is to require the use of positive behavior supports intended to encourage individual growth, improve quality of life, and reduce the use of unnecessary intrusive measures for persons funded through the department. Positive behavior support focuses on what is important to the person as well as what is important for the person when encouraging growth and change. This rule prohibits the use of seclusion or the use of abusive or demeaning procedures, or procedures that cause pain or discomfort except as provided for in the emergency procedures allowed for in ARM 37.34.1420. This subchapter applies to persons receiving services from community-based providers that are funded entirely or in part by the department.

(1) All children and adults receiving services from community-based providers that are funded entirely or in part by the department must be afforded the protections imposed by these rules. Any provider contracting with the department to provide services to persons with developmental disabilities must conduct its activities in accordance with these rules.

This rule has been repealed.

For purposes of this subchapter, the following definitions apply:

(1) "Advocate" is defined in ARM 37.34.102.

(2) "Alternative behavior" means a behavior that can, but is not likely to occur at the same time as a challenging behavior.

(3) "Challenging behavior" means a behavior that presents a risk or potential risk to the health or safety of a person or to others.

(4) "Contingent observation" means a method of decreasing a challenging behavior by telling the person what they are doing wrong and asking the person to not participate in the ongoing activity for a short period of time, to be seated nearby, and to observe others engaging in a specific appropriate behavior and receiving positive reinforcement for it. The person who is observing the behavior may rejoin the activity group when the person agrees to behave appropriately. The person's appropriate behavior is then reinforced when the person exhibits the appropriate behavior.

(5) "Contingent access to social activities and personal possessions including personal funds" means that upon the occurrence of a specified challenging behavior, the person's attendance at social activities and use of personal possessions including personal funds is restricted.

(6) "Corporal punishment" means knowingly and purposefully inflicting physical pain on a person as a disciplinary measure.

(7) "Educational fine" means a system of decreasing challenging behavior based upon a token or point system. A small fine is levied contingent upon the occurrence of a challenging behavior. A teaching episode must accompany each fine which includes a description of the challenging behavior, the amount of the fine, instruction on the appropriate forms of behavior, and the opportunity for the person to "earn back" a portion of the fine for practicing the appropriate behaviors.

(8) "Exclusion time out" means a method of decreasing a challenging behavior by requiring a person to leave an ongoing reinforcing situation for a period of time, contingent on the occurrence of some previously specified challenging behavior. Unlike contingent observation, the person is not instructed to observe the appropriate behavior of others.

(9) "Graduated guidance" means systematically providing the minimum degree of physical assistance necessary to ensure that a desired behavior occurs. Graduated guidance is a technique combining physical guidance and fading in which the physical guidance is systematically and gradually reduced and faded according to the person's responsiveness. Graduated guidance techniques do not include physical restraint as a primary component. Graduated guidance is assistive rather than restrictive and does not involve forced compliance.

(10) "Mechanical restraint" means a physical device used to restrict the person's movement or restrict the normal function of the person's body. The definition does not include the following:

(a) physical equipment or orthopedic appliances, surgical dressings or bandages, supportive body bands or other restraints necessary for medical treatment, routine physical examinations, or medical tests;

(b) devices used to support functional body position or proper balance; or

(c) equipment used for safety during transportation.

(11) "Overcorrection" means a technique used to decrease a challenging behavior. The two main types of overcorrection are restitutional overcorrection and positive practice overcorrection.

(12) "Physical enforcement" means a person is required to perform a behavior by another person using physical contact with them.

(13) "Physical prompt" means a person physically guides the person to perform a response.

(14) "Physical restraint" means the restriction of the person's movement by holding or applying physical pressure to bring the person's behavior under control in order to avoid the risk of serious harm to the person, other person(s), or to the environment. The term physical restraint does not include the use of physical prompt or graduated guidance.

(15) "Positive practice overcorrection" means a form of overcorrection requiring the person engaging in a challenging behavior to intensely practice a specified appropriate alternative behavior.

(16) "Required relaxation" means requiring the person to relax quietly for a period of time after the occurrence of a challenging behavior.

(17) "Response cost" means a procedure reducing accumulated reinforcement upon the occurrence of a challenging behavior, thus making the behavior less likely to occur.

(18) "Restitutional overcorrection" means a form of overcorrection requiring a person engaging in a challenging behavior to restore the environment to its previous state and improve on the previous conditions.

(19) "Restriction of rights" means procedures which involve withdrawal, delay, or curtailment of rights which the person may ordinarily exercise. Such withdrawal is usually in connection with a program through which the person may exercise such rights by performing specified behaviors.

(20) "Seclusion" means requiring the person to remain alone in a room or any area behind a closed door which prevents them from leaving or being observed for a period of time.

(1) Positive behavior support is a set of evidence-based strategies used to reduce problem behavior by teaching new skills and making changes in the person's environment to improve quality of life.

(2) The foundation of positive behavior support is the functional behavior assessment described in ARM 37.34.1411.

(3) Positive behavior support strategies include:

(a) understanding how and what the person is communicating;

(b) understanding how other's presence, voice, tone, words, actions, and gestures impact the person and modifying these as necessary;

(c) supporting the person in communicating choices and wishes;

(d) supporting staff to change their behavior when it has a detrimental impact;

(e) temporarily avoiding situations that are too difficult or uncomfortable for the person, unless the health or safety of the person or the established treatment plan is compromised;

(f) allowing the person to exercise as much control and decision making as possible over day-to-day routines;

(g) assisting the person to increase control over life activities and their environment;

(h) teaching the person coping, communication, and emotional self-regulation skills;

(i) anticipating situations that will be challenging and assisting the person to cope or to respond in a calm way;

(j) providing opportunities for the person such as valued work, enjoyable physical exercise, and preferred recreational activities;

(k) modifying the environment to remove stressors for the person; and

(l) ensuring all medical needs and conditions are identified and addressed.

(4) The person's plan of care must incorporate the positive behavior support plan.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) A functional behavior assessment is the gathering of information about a person's behavior based upon multiple information sources, including:

(a) a review of the person's records;

(b) personal observations;

(c) interviews with support providers;

(d) interviews with the person; and

(e) interviews with others who have personal knowledge of the person.

(2) A functional behavior assessment must include:

(a) a clear and measurable description of the challenging behavior, including frequency, duration, intensity, and severity of the behavior;

(b) a clear description of the need to alter the behavior;

(c) a clear description of medical, psychological, psychiatric, physiological, and environmental conditions in terms of how they may affect the occurrence of the challenging behavior;

(d) the events, times, and situations that predict both the occurrence and the nonoccurrence of the challenging behavior and a description of the events immediately preceding and following the behavior;

(e) summary statement(s) regarding the function(s) that may be maintaining the challenging behavior;

(f) data confirming the function of the challenging behavior and the strategies for reducing or eliminating the challenging behavior;

(g) functional alternative behavior that serves to meet the same function as the challenging behavior; and

(h) a clear and measurable procedure that will be used to alter the challenging behavior.

(1) The behavior support plan is a formal written plan to address needs identified in a person's plan of care and must be developed for all persons engaging in challenging behavior. A behavior support plan must be developed as required by ARM 37.34.1420(4). The behavior support plan must be based on a functional behavior assessment as described in ARM 37.34.1411.

(2) Behavior support plans:

(a) utilize the basic principles of human behavior and learning and the principles of applied behavior analysis;

(b) emphasize the development of the functional alternative behavior using positive approaches, positive behavior intervention, and positive reinforcement procedures;

(c) use the least intervention possible;

(d) describe how to rearrange environments, alter curricula or tasks, and adjust schedules;

(e) are practical and appropriate for the settings where they will be implemented, for the person and for those who will implement the methods described;

(f) are evaluated through timely review of specific data on the progress and effectiveness of the procedure;

(g) identify functional alternative behavior that meets the same function as the challenging behavior;

(h) provide a clear and measurable procedure used to alter the challenging behavior;

(i) include a description of any restrictions necessary to protect the health and safety of the person, describe why the restrictions are necessary, and list the criteria for removing them;

(j) include reactive strategies to ensure the safety of the person and others; and

(k) are included in the person's plan of care.

(3) A behavior support plan must not include the use of seclusion, or the use of aversive, abusive or demeaning procedures, procedures that cause pain or discomfort except as provided for in the emergency procedures allowed for in ARM 37.34.1420.

(4) Use of the person's behavior support plan requires prior written consent from the following for approval:

(a) the person;

(b) the person's parent(s) if the person is under 18 years of age; and

(c) the legal representative, if one has been appointed by the court.

(5) The person's planning team and the person's providers are responsible for the implementation of the person's behavior support plan.

(6) A behavior support plan must include appropriate measures for training and monitoring staff performance throughout the implementation of the behavior support plan.

This rule has been repealed.

(1) The following may not be restricted for the purposes of a positive behavior support program:

(a) education and training services;

(b) a safe environment to live, work, and receive treatment;

(c) an individual plan of care;

(d) prompt medical and dental care;

(e) a nourishing, well-balanced diet;

(f) assistance of an advocate;

(g) opportunity for religious worship; and

(h) just compensation for work performed.

(2) Corporal punishment and verbal and physical abuse are prohibited in the delivery of services to a person.

This rule has been repealed.

(1) Emergencies are situations in which the person, other person(s), or the environment is at imminent risk of serious harm or damage due to the person's challenging behavior.

(2) If an emergency occurs the following procedures may be used if necessary to prevent the imminent risk of serious harm or damage to the person, other person(s), or the environment:

(a) physical restraint; or

(b) mechanical restraint, upon written order by a licensed physician for medical reasons.

(3) Incident reporting must meet the requirements described in ARM Title 37, chapter 34, subchapter 15.

(4) A behavior support plan, as described in ARM 37.34.1412, must be developed for the person if physical restraint is used three times in a three-month period.

This rule has been repealed.

(1) The following restricted procedures may be used for up to 90 calendar days as part of a behavior support plan that is developed in accordance with ARM 37.34.1412 and approved in accordance with (2):

(a) physically enforced contingent observation;

(b) contingent access to personal possessions;

(c) contingent access to personal funds;

(d) educational fines;

(e) physically enforced exclusion time out;

(f) physically enforced overcorrection;

(g) physically enforced positive practice overcorrection;

(h) physically enforced restitutional overcorrection;

(i) contingent access to social activities;

(j) response cost; and

(k) physically enforced required relaxation.

(2) A behavior support plan that includes the use of restrictive procedures must be approved by:

(a) a board-certified behavior analyst (BCBA);

(b) a family support specialist with an autism endorsement (FSS-AE);

(c) a person with an Institute for Applied Behavior Analysis (IABA) consultant certification; or

(d) a person with a degree in applied behavior analysis, psychology, or special education who has provided documentation of training and experience in the use of the principles of applied behavior analysis in the habilitation of person(s) with developmental disabilities and the development of behavior support plans to the developmental disabilities program director.

(3) A copy of the behavior support plan incorporating restricted procedures as listed in (1) must be sent to the developmental disabilities program director within three working days after approval as required in (2).

(4) The developmental disabilities program director or their designee must provide prior written authorization for the continued use of the restricted procedures after 90 calendar days and the department designee is responsible for reviewing and monitoring the continued implementation and effectiveness of the behavior support plan.

(5) The restricted procedures in (1) may only be used in the delivery of services to a person as authorized by these rules.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) These rules govern the reporting and handling of incidents which harm or could result in harm to persons with a developmental disability who receive services funded by the developmental disabilities program of the department.

(a) The Developmental Disabilities Program Incident Management Procedures Manual, dated February 1, 2013, sets forth further requirements and criteria that govern the incident management system for the developmental disabilities program of the department.

(b) The department adopts and incorporates by reference the Developmental Disabilities Program Incident Management Procedures Manual, dated February 1, 2013.

(c) A copy of the manual may be obtained through the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(d) Incidents constituting abuse and neglect of a child as defined in 41-3-102, MCA or abuse, neglect, and exploitation of a person with a developmental disability as defined in 52-3-803, MCA are subject to the statutory and rule provisions governing the reporting, investigation, and protection of those circumstances.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The department has been granted by the United States Department of Health and Human Services (HHS) the authority to provide Medicaid home and community children's autism services to children who are determined to have autism. The authority to implement this program is provided in 42 USC 1396n(c) and 42 CFR 441.300 441.310. These rules implement in Montana the Medicaid home and community services program for children with autism as approved by HHS as the 0667 Home and Community Services Waiver.

(1) The Medicaid home and community services program for children with autism is available to serve:

(a) children who would otherwise require the level of care provided in an intermediate care facility for the mentally retarded (ICF/MR); and

(b) for whom services provided will not jeopardize the child's health and safety.

(2) Eligibility of applicants to be considered for acceptance into the Medicaid home and community services program for children with autism is determined as provided in ARM 37.34.1905.

(3) Acceptance into the Medicaid home and community services program for children with autism is determined as provided in ARM 37.34.1907.

(4) Services and acceptance into the Medicaid home and community services program for children with autism are available only to the extent that the federal approval of the state's program permits and that available funding allows.

(a) In accordance with current federal approval, the program has only fifty placements available.

(5) The department, in order to comply with federal requirements or to limit expenditures of available funding, may:

(a) reduce the number of Medicaid children that may be served through this program;

(b) postpone or waive implementation of a particular service of the program; or

(c) eliminate one or more of the services of the program.

(1) Through the Medicaid home and community services program for children with autism, the department determines a child is eligible to be considered for acceptance into the program if the child:

(a) is the age of 15 months through the age of four years;

(b) is eligible for Medicaid;

(c) is diagnosed as having Autism Spectrum Disorder and has adaptive disorder training needs as determined by the eligibility determination process established by the department.

(2) Eligible children are placed on the waiting list in accordance with ARM 37.34.1907.

(3) Eligible children turning five years of age are removed from the eligibility list on their fifth birthday.

(4) Eligible children are not required to have a diagnosis of mental retardation.

(1) A child determined eligible to be considered for acceptance into the children's autism program will be placed on the waiting list for services through the completion of the waiting list application form. The child's application form has a number assigned to it by the program. Service opportunities for the children's autism program are awarded by means of random selection using a computer program that generates a number based on the range of numbers representing the children on the waiting list for the Developmental Disabilities Program (DDP) region of the state where the service opportunity exists.

(2) A service opportunity is awarded as it becomes available.

(3) The allocation of service opportunities is based proportionately on the population of each DDP region derived from US census data.

(4) When the child exits the waiver, the service opportunity will stay within the DDP region except as provided for in (5).

(5) In the event that unused capacity exists in a particular DDP region, an available service opportunity is allocated to the region with the lowest enrolled children per capita.

(1) A child accepted into the program may receive up to three years of available service.

(a) If requested by the family, a child who is transitioning from the children's autism program and who meets the eligibility criterion for developmental disabilities services may be placed on the waiting list for the home and community-based services 0208 waiver program.

(b) If requested by the family, case managers for children enrolled in the autism program shall conduct ongoing transition and other service coordination activities.

(1) The requirements governing reimbursement for Medicaid home and community children's autism services are found at ARM 37.34.3001, 37.34.3002, and 37.34.3007.

(1) The following services may be provided by the Medicaid home and community-based autism services waiver:

(a) Children's Autism Training, as provided in ARM 37.34.1923 and 37.34.1925;

(b) Waiver Funded Children's Case Management, as provided in ARM 37.34.1927 and 37.34.1929;

(c) Respite, as provided in ARM 37.34.1931 and 37.34.1933;

(d) Adaptive Equipment, as provided in ARM 37.34.1939 and 37.34.1914;

(e) Environmental Modifications, as provided in ARM 37.34.1935 and 37.34.1937;

(f) Occupational Therapy, as provided in ARM 37.34.1943 and 37.34.1945;

(g) Physical Therapy, as provided in ARM 37.34.1947 and 37.34.1949;

(h) Speech Therapy, as provided in ARM 37.34.1951 and 37.34.1953;

(i) Transportation, as provided in ARM 37.34.1955 and 37.34.1957;

(j) Individual Goods and Services, as provided in ARM 37.34.1959 and 37.34.1961; and

(k) Program Design and Monitoring, as provided in ARM 37.34.1963 and 37.34.1965.

(2) Services available to a child through the program are limited to the services specified in the child's plan of care.

(1) The services of the Medicaid home and community program for children with autism may be provided by one or more of the following, as determined by the department:

(a) a Medicaid provider agency through contract with the department;

(b) a subcontractor for a Medicaid provider agency that is recognized by the department as an "Organized Health Care Delivery System" (OHCDS);

(c) an individual Medicaid provider through contract with the department; and

(d) an individual Medicaid provider without a contract with the department.

(1) The department must review and approve the individual family service plan.

(1) The department's notices and fair hearings are provided for in ARM 37.34.919.

(1) The department will give the parent or legal representative of the child the opportunity to make a choice, on behalf of the child, between placement in an ICF/MR or in the Medicaid home and community services program.

(2) The parent or legal representative must be informed of the feasible alternatives in the community, if any, available through the Medicaid home and community services program.

(1) Children's autism training is a direct training service designed to assist the child in acquiring, retaining, and generalizing the self-help, socialization, cognitive, communication, organization skills, and the positive behaviors necessary to function successfully in home and community settings.

(2) Children's autism training includes:

(a) social skills and related skills to enhance participation across all environments (school, home and community settings) and relationships;

(b) a functional communication system which may include expressive verbal language, receptive language and nonverbal communication skills, and augmentative communication;

(c) increased engagement and flexibility in the exhibition of developmentally appropriate behaviors;

(d) replacement of inappropriate behaviors with more conventional and functional behaviors;

(e) working with caregivers and others in the environment to promote the child's competence and positive behavior;

(f) fine and gross motor skills used for age-appropriate functional activities, as needed;

(g) cognitive skills relating to play activity and academic skills;

(h) adaptive behavior and self-care skills to enable the child to be more independent; and

(i) independent exhibition of organizational skills.

(1) The children's autism trainer provides hands-on training using evidence-based applied behavior analysis practice and methods. Training goals are outcome-based and progress towards goals is evidenced by training data.

(2) The training effort occurs where the child lives, attends child care, and/or socializes with peers. The bulk of training may occur in the child's home. Training may be delivered in group settings with same age peers or in one-to-one settings, based on the assessed needs of the child. The majority of training is delivered in one-to-one settings.

(3) The trainer must complete the training requirements as outlined in ARM 37.34.2107.

(4) The trainer receives training developed by the provider agency within 30 days of hire, which includes:

(a) abuse reporting;

(b) incident reporting;

(c) client rights;

(d) client confidentiality;

(e) first aid training; and

(f) any specialty training related to the needs of the children served as outlined in the plan of care.

(5) Trainers must take the college of direct support training provided through the department, including the modules specific to autism within 30 days of hire.

(6) Trainers assisting with medications must be certified in accordance with ARM 37.34.114.

(7) The employer shall maintain documentation verifying that a trainer providing direct client services has had an acceptable criminal background check in accordance with ARM 37.34.2102(2).

(1) Waiver-funded children's case management services are services furnished to assist children in gaining access to needed medical, social, education, and other services.

(2) Waiver-funded children's case management includes the following assistance:

(a) comprehensive assessment and periodic reassessment of the child's needs to determine the need for any medical, educational, social, or other services;

(b) development and periodic revision of a specific care plan;

(c) referral and related activities to help an eligible child to obtain needed services;

(d) monitoring and follow-up activities including activities and contacts that are necessary to ensure the plan of care is implemented and adequately addresses the child's needs;

(e) contacts with non-eligible persons that are directly related to identifying the needs and supports for helping the eligible child to access services;

(f) upon request, assisting the department in scheduling meetings and providing information to department staff responsible for completing initial and ongoing level of care activities; and

(g) locating suitable alternative placement, as necessary when the child's health or safety is at risk.

(1) A case manager shall conduct a face-to-face visit with the parent or legal representative, at least monthly, for the purpose of reviewing any need for change in the plan of care, based on the changing needs of the child or the family.

(2) A case manager must have a four year degree in a human services field, three years of experience in working with children with developmental disabilities, and current family support specialist certification.

(1) Respite care includes any services designed to meet the safety and daily care needs of the child and the needs of the child's caregiver in relation to reducing stress generated by the provision of constant care to the child receiving waiver services.

(1) Persons providing respite services will be in compliance with all state and federal respite standards.

(2) Respite services are delivered in conformity with the plan of care.

(3) Respite is considered an ancillary service. The sum of all ancillary service costs may not exceed $4,000 annually.

(4) Respite provider is subject to approval by the family, and must possess any competencies outlined by the family in the plan of care which are related to the specific needs of the child.

(5) A person providing the respite service must be 16 years of age or older.

(6) Respite services are selected in collaboration with the child's parent or legal representative and are provided by persons chosen and trained by the family.

(7) The amount and frequency of respite care is included in each child's plan of care.

(1) Environmental modifications are physical adaptations to the home, required by the child's plan of care, which are necessary to ensure the health, welfare, and safety of the child, or which enable the child to function with greater independence in the home, and without which the child would require institutionalization.

(2) Environmental modification services are measures that provide the child with accessibility and safety in the environment so as to maintain or improve the ability of the child to remain in community settings and employment.

(1) An environmental modification must:

(a) relate specifically to and be primarily for the child's disability;

(b) have utility primarily for the child who has a disability;

(c) not be an item or modification that a family would normally be expected to provide for a non-disabled family member;

(d) not be in the form of room and board or general maintenance; and

(e) meet the specifications, if applicable, for the modification set by the American National Standards Institute (ANSI).

(2) Environmental modification is considered an ancillary service; the sum of all ancillary service costs may not exceed $4,000 annually.

(1) Adaptive equipment is equipment necessary to increase independent functioning in completing activities of daily living when such equipment is not available through other sources.

(1) Adaptive equipment will conform to the following criteria:

(a) relate specifically to and be primarily for the child's disability;

(b) have utility primarily for the child who has a disability;

(c) not be an item or modification that a family would normally be expected to provide for a non-disabled family member;

(d) not be in the form of room and board or general maintenance; and

(e) meet the specifications, if applicable, for the modification set by the American National Standards Institute (ANSI).

(2) Adaptive equipment may be provided as needed to enable family members or other caregivers to provide the care needed by the child.

(3) Adaptive equipment is considered an ancillary service; the sum of all ancillary service costs may not exceed $4,000 annually.

(1) Occupational therapy services are defined in 37-24-103, MCA and may include evaluation, consultation, training, and treatment.

(1) Occupational therapy must meet the requirements for occupational therapy services required by ARM 37.86.606, except that under the Medicaid home and community services program:

(a) maintenance therapy is reimbursable and there are no limitations on visits for maintenance therapy;

(b) training for persons providing direct care is reimbursable; and

(c) participation in the interdisciplinary team planning process is reimbursable.

(2) Occupational therapy is considered an ancillary service. The sum of all ancillary service costs may not exceed $4,000 annually.

(1) Physical therapy services are defined in 37-11-101(7), MCA.

(2) Physical therapist may provide treatment training programs that are designed to:

(a) preserve abilities for independent function; and

(b) prevent, insofar as possible, irreducible or progressive disabilities.

(3) Therapists may also provide consultation and training to staff or caregivers who work directly with waiver children.

(1) Physical therapy must meet the requirements for physical therapy services required by ARM 37.86.606, except that under the Medicaid home and community services program:

(a) maintenance therapy is reimbursable and there are no limitations on visits for maintenance therapy;

(b) training for persons providing direct care is reimbursable; and

(c) participation in the interdisciplinary team planning process is reimbursable.

(2) Physical therapy is considered an ancillary service. The sum of all ancillary service costs may not exceed $4,000 annually

(1) Speech therapy services are defined in 37-15-102(8), MCA and may include evaluation, consultation, training, and treatment.

(2) Speech therapy services may include:

(a) screening and evaluation of children with respect to speech and hearing functions;

(b) comprehensive speech and language evaluations when indicated by screening results;

(c ) participation in the continuing interdisciplinary evaluation of children for purposes of beginning, monitoring, and following up on individualized habilitation programs; and

(d) treatment services as an extension of the evaluation process, which include consultation with appropriate people involved with the child for speech improvement and speech education activities to design specialized programs for developing each child's communication skills in comprehension, including speech, reading, auditory training, and skills in expression.

(3) Therapists may also provide consultation and training to staff or caregivers who work directly with waiver children.

(1) Speech therapy must meet the requirements for speech therapy services required by ARM 37.86.606, except that under the Medicaid home and community services program:

(a) maintenance therapy is reimbursable and there are no limitations on visits for maintenance therapy;

(b) training for persons providing direct care is reimbursable; and

(c) participation in the interdisciplinary team planning process is reimbursable.

(2) Speech therapy is considered an ancillary service. The sum of all ancillary service costs may not exceed $4,000 annually.

(1) Transportation services are offered in order to enable children served on the waiver to gain access to waiver and other community services, activities, and resources specified by the plan of care.

(1) Transportation services through the waiver must be offered in accordance with the plan of care.

(2) Persons providing transportation must be licensed, insured, and drive a registered vehicle in accordance with the motor vehicle laws of the state of Montana.

(3) Reimbursement for rides provided a legally responsible person or others must be related to the specific disability needs of a child, as outlined in the plan of care.

(4) Under no circumstances will medically necessary transportation be reimbursed through the waiver if the service is reimbursable through Medicaid state plan transportation.

(5) Transportation is considered an ancillary service. The sum of all ancillary service costs may not exceed $4,000 annually.

(1) Individual goods and services are services, supports, or goods that enhance opportunities to achieve outcomes related to living arrangements, relationships, inclusion in the community, and work as clearly identified and documented in the plan of care.

(1) Items covered through individual goods and services must meet the following requirements:

(a) the item or service is designed to meet the child's functional, medical, or social needs and advance the desired outcomes in the plan of care;

(b) the item or service is not prohibited by federal or state statutes or regulations;

(c) the item or service is not available through another source;

(d) the service does not include experimental goods or services; and

(e) one or more of the following additional criteria are met:

(i) the item or service would increase the child's functioning related to the disability;

(ii) the item or service would increase the child's safety in the home environment; or

(iii) the item or service would increase independence from other Medicaid services.

(2) Recreational activities provided through individual goods and services may be covered only to the degree that they are not diversional in nature and are included in a planning objective related to a specific therapeutic goal.

(3) Individual goods and services are reimbursable only if:

(a) individual goods and services must be approved by the planning team prior to purchase; and

(b) goods and services purchased on behalf of the child by nonemployees acting on behalf of the child are reimbursable only if receipts for such purchases are submitted to the agency that has a contract with the department.

(4) The department assures that services, goods, or supports provided for through this definition are not available through the Individuals with Disabilities Education Act (IDEA) or Section 110 of the Rehabilitation Act or available through any other public funding mechanism.

(5) Individual goods and services is considered an ancillary service. The sum of all ancillary service costs may not exceed $4,000 annually. Individual goods and services projected to exceed an annual aggregate amount of $2,000 require approval by the program regional manager.

(1) Program design and monitoring is designed to provide the formal training protocols and methods used by the children's autism trainer in helping the child acquire, retain, and generalize the self-help, socialization, cognitive, communication, organizational skills, and the positive behaviors necessary to function successfully in home and community-based settings.

(2) Training goals must be outcome-based and progress toward goals will be evidenced by training data.

(3) Training efforts will occur in the customary and usual community locations where the child lives, plays, and socializes with peers. Training may be delivered in group settings with same aged peer or in one-to-one settings, based on the assessed needs of the child. The majority of training will be delivered in one-to-one training.

(1) Staff providing program design and monitoring (PDM) must have a family support specialist certification with an autism endorsement or be a Board Certified Behavioral Analyst.

(2) Staff providing PDM shall provide the following services:

(a) develop and monitor the implementation of formal and informal training methods and provide training specific to the formal training plan and the informal interaction techniques used by the children's autism trainer, family members and others who work with or interact with the child; and

(b) provide general assistance and support to individuals who provide unpaid support, training, companionship or supervision to the child.

(1) These rules provide a process by which a contracted provider of state-funded developmental disabilities home and community-based services may seek to discontinue the delivery of services to a person who is in receipt of services from that provider.

(1) When a person receiving developmental disability community services from a service provider refuses to cooperate in service delivery as provided for in their plan of care or otherwise fails to substantively engage in their plan of care or when, following good faith efforts, the person's health and safety needs cannot be met by the provider, the provider may follow the process provided in these rules to be relieved of service delivery responsibilities for the person. The provider will continue to provide services to ensure the persons' health and safety during the course of the process provided for in this rule.

(2) The provider who wishes to discontinue the services must provide notice of the provider's intent to discontinue services in writing and submit the notice to:

(a) the regional manager or designee of the developmental disabilities program (DDP) of the region in which the person resides;

(b) the person with a developmental disability;

(c) the case manager for the person;

(d) the legal representative for the person, if applicable;

(e) the advocate for the person, if applicable; and

(f) the designee at the state facility, if applicable.

(3) The statement of intent to discontinue services must include:

(a) the issues that the provider contends cause the need to discontinue the services; and

(b) thorough documentation of the past and current efforts made by the provider and others to provide the services to the person.

(4) The regional manager or designee will schedule a meeting within two working days after the receipt of the notice of intent to discontinue services from the provider. The meeting will include the regional manager or the regional manager's designee, the members of the person's plan of care team, the provider, and if applicable, a designee from the state facility. The meeting may be conducted telephonically. If the person's legal representative is not available within two working days, the meeting must be scheduled at the earliest possible time the legal representative is available. If the person or a legal representative is unable to participate in the plan of care meeting, the case manager must document the reasons for the absence and the attempts made to reschedule the meeting with the person or the person's legal representative.

(5) The purpose of the meeting is to review the basis for the notice and determine if a change in the configuration of the current services or additional supports may assist the person to remain in or return to services with the current provider and, if so, identify those services or supports. If the planning team determines additional services or supports may assist the person to remain with the current provider, the planning team must develop a supplemental plan of care which identifies the actions to implement the determination for the person's services.

(6) The department reviews the supplemental plan of care developed by the planning team to assess the feasibility of the plan and to suggest further changes if desired. If the plan provides for the delivery of additional services or for interim supports to the person at an additional cost, the department must approve those through an adjustment to the person's individual cost plan.

(7) If the planning team cannot reach consensus on the implementation of a supplemental plan of care, the person(s) who does not agree may submit their disagreement along with the justification for their disagreement to the DDP program director or designee. The DDP program director or designee must:

(a) make a determination within three working days; and

(b) provide the determination in writing to the members of the planning team.

(8) If a person who is the subject of a discontinuation of services process is admitted to Montana Developmental Center, Montana State Hospital, a hospital, or to any other facility, the person's ongoing discontinuation of services process and all applicable dates are suspended until the person returns to the community service unless the department determines that the person's admission is on a long-term basis. Admission to a facility is inclusive of commitment, emergency detention, emergency admission, court-ordered precommitment detention, voluntary admission, or any other process resulting in a person being placed in a facility.

(9) If it is determined in the course of planning that an alternative provider is needed, the case manager will assist the person, the legal representative, or both in seeking an alternative provider. The case manager will place the person on the port list. If additional funding is required, the case manager will also place the person on the waiting list for screening into an opening with sufficient funding.

(10) A provider must, in good faith, participate in the implementation of a supplemental plan of care.

(11) The regional manager or designee will schedule a meeting between 15 to 30 calendar days prior to the expiration of the 90 calendar days to review the outcome of the supplemental plan of care. The meeting will include the regional manager or the regional manager's designee, the members of the person's plan of care team, the provider, and, if applicable, a designee from the state facility. The meeting may be conducted telephonically. If the person's legal representative is not available within two working days, the meeting must be scheduled at the earliest possible time the legal representative is available. If the person or a legal representative is unable to participate in the plan of care meeting, the case manager must document the reasons for the absence and the attempts made to schedule the meeting with the person or the person's legal representative.

(12) At the expiration of 90 calendar days following the receipt by the department of a proper notice of intent to discontinue services from a provider, the provider may proceed with the discontinuation of services for the person, if the provider, as determined by the department and the planning team, has participated in good faith in a supplemental plan of care if applicable, and the basis for the discontinuation action remains.

(13) A provider must abide by applicable statutes or regulations of the state of Montana regarding the relationship between the provider as the landlord and the person as the tenant.

(14) The person or the person's legal representative maintains their right to a fair hearing as provided for in ARM 37.5.115.

(1) Each contractor providing Part C services must have a written policy covering discontinuation of Part C or FES services.

(2) Prior to providing Part C or FES services to a family, the contractor will have each family read the discontinuation of services policy referenced in (1), or will read the policy to the family, and have the family acknowledge receipt of the discontinuation criteria by their signature.

(3) The contractor must have documentation in each family's file that confirms the following:

(a) the reason for discontinuation of services;

(b) for Part C, notification provided to the family of the pending discontinuation of services in accordance with the requirements of CFR Section 303.421; and

(c) notification provided to the family of the grievance procedure outlined in ARM 37.34.109.

(4) The contractor must specify the reason for discontinuation of services. The reason must include one of the following:

(a) the family declines services, either by:

(i) notifying the contractor of their decision to decline services; or

(ii) failing to respond to at least two attempts by the contractor to contact them regarding continuation of services. Contractors must document these attempts in the family file.

(b) the person is transitioned into a more appropriate service;

(c) temporary services, as determined at onset, have reached conclusion;

(d) the person is determined ineligible;

(e) the contractor has evidence of misuse of agency funds by the family;

(f) the family moves from the service area; or

(g) the death of the person.

(1) A person who is aggrieved of a change in services resulting from a discontinuation of services process under these rules is entitled to a fair hearing as provided for at ARM 37.5.115.

(1) This subchapter specifies requirements applicable to provision of developmental disability program services. These rules are in addition to requirements generally applicable to Medicaid providers as otherwise provided in state and federal statute, rules, regulations, and policies.

(2) A contractor who contracts to provide developmental disabilities services funded by the developmental disabilities program must employ, in the provision of services to persons eligible for those services, staff who are able to demonstrate the ability to meet the needs of the persons that the contractors serve.

(3) A contractor who contracts to provide developmental disabilities services is subject to this subchapter.

(4) A contractor providing transportation services, that are also available to the general public, who contracts with the department only to provide transportation services is not subject to this subchapter.

(1) The contractor must have, for each staff position, a written position description that specifies the physical requirements and the minimum standards for education and experience.

(2) The contractor must conduct a screening and a background check of a person prior to a person assuming their duties and responsibilities. A screening and background check must include a criminal background check through the Montana Department of Justice or another background check entity that provides a national background check.

(3) The contractor must verify to the department, upon hire, that each staff person has the ability to meet the competencies to perform the tasks and responsibilities of their position in the provision of developmental disabilities program services.

(4) The contractor must verify to the department, annually, that each staff person has the ability to meet the competencies to perform the tasks and responsibilities of their position in the provision of developmental disabilities program services, as determined by completion of the training requirements within the established timeframes.

(5) Upon hiring of a staff person, inclusive of administrative and management services, the contractor must review the list of excluded individuals and entities maintained by the Office of Inspector General of the U.S. Department of Health and Human Services and the excluded parties list system at the System for Award Management maintained by the federal General Services Administration (GSA) to determine whether the person appears on either of these lists and if the person appears on one of the lists, must:

(a) report the listing to the department immediately; and

(b) take the appropriate action to terminate the person if the person is employed in a manner that is not permissible under the applicable federal requirements.

This rule has been repealed.

This rule has been repealed.

(1) For each person served, the contractor must provide the number of staff with appropriate training and guidance required to ensure the quality and effectiveness of services to be delivered in accordance with the person's plan of care and individual cost plan.

(2) The contractor must ensure the presence of on-site awake night staff in applicable programs, sufficient to meet the needs of the persons the contractor serves.

(3) For noncongregate services or agency-based self-directed services, the contractor must provide for emergency back-up staff sufficient to meet the needs of the persons the contractor serves. This requirement is satisfied only if, in lieu of the absent caregiver, the on-call back-up staff actually appear and engage in providing the service.

This rule has been repealed.

(1) The commitment of a person to the Montana Development Center as a person with a serious developmental disability in need of the services of that residential facility or commitment under a community treatment plan is subject to statutory procedures and requirements of Title 52, chapter 20, part 1, MCA, inclusive of the formal residential facility screening team process. The Manual for the Screening of Persons Being Considered for Civil Commitment to the Montana Development Center or to a Community Treatment Plan, effective August 28, 2012, sets forth further requirements and criteria that govern the residential facility screening team.

(2) The department adopts and incorporates by reference the Manual for the Screening of Persons Being Considered for Civil Commitment to the Montana Development Center or to a Community Treatment Plan, effective August 28, 2012.

(3) A copy of the manual may be obtained through the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(2) If the residential facility screening team recommends commitment or recommitment, the recommendation goes to the district court, and the parties can request a hearing from the court, as provided in 53-20-125 , MCA.

(1) Developmental disabilities professionals are certified for the following purposes:

(a) to recommend, when requested by a party to a commitment proceeding to the district court or by the district court, the most appropriate habilitation plan or treatment plan for an individual for whom commitment or recommitment is being sought;

(b) to evaluate at the request of the residential facility screening team, as provided in ARM 37.34.2307 and 37.34.2309, an individual being considered for commitment or recommitment, by gathering information, conducting, as directed by the residential facility screening team or as requested by the individual's case manager, psychological testing and assessment, compiling information, writing reports to the residential facility screening team, and providing a report to the residential facility screening team to assist in the team's review of the case regarding commitment.

(2) The purposes of the certification committee are to:

(a) review all applications of persons requesting certification as developmental disabilities professionals;

(b) certify developmental disabilities professionals in accordance with these rules; and

(c) perform other duties set forth by these rules or assigned to the certification committee by the director of the department.

(3) The certification committee for developmental disabilities professionals includes the following members:

(a) a person appointed by the governor;

(b) four persons appointed by the director of the department, at least two of whom represent the developmental disabilities program and, who are familiar with the roles and responsibilities of developmental disabilities professionals.

(4) Members of the certification committee shall serve at the convenience of the appointing authority.

(5) The person appointed by the governor serves as chairperson of the committee. Meetings of the certification committee shall be called by the chairperson. The certification committee meets as needed, but no fewer than 4 times per year, to review applicants.

(a) submission of application forms by the applicant;

(b) a review by the certification committee, within 90 days of receipt of all required application materials, to determine the qualifications of the applicant for certification;

(c) an issuance or denial of certification or provisional certification of the application by the certification committee;

(i) the certification committee may issue provisional certification that limits the specific services, the conditions under which the developmental disabilities professional can provide services, or the time period such certification shall be effective, or any combination thereof;

(d) notification to the applicant within 30 days of the committee's determination.

(2) Certification expires 3 years from the date of certification.

(3) The certification committee may revoke certification for cause by notifying the certified developmental disabilities professional in writing of the reasons for revocation at least 10 days prior to the effective date of revocation.

(4) The certification committee establishes and implements procedures to assure timely and efficient review of applicants.

(a) a licensed psychologist;

(b) a licensed psychiatrist; or

(c) a person with a master's degree in psychology, who:

(i) has training and experience in psychometric testing and evaluation; and

(ii) has experience in the field of developmental disabilities.

(2) Experience in the field of developmental disabilities may include:

(a) evaluation;

(b) planning;

(c) testing;

(d) treatment; and

(e) consultation.

(3) Applicants must supply transcripts and other appropriate records that document relevant training and experience.

(4) The certification committee retains the right to determine the appropriateness of any experience for certification purposes.

(a) The notice of appeal shall be directed to the director of the department.

(b) The appeal shall be in writing and shall set forth the nature of the grievance and arguments supporting the grievance and actions desired. The appealing party may also present oral argument.

(c) The appealing party shall be notified in writing 10 days prior to the hearing. The written notice shall contain the date, time and location of the hearing.

(2) All findings of the department director or designee are binding on the certification committee.

(1) The following requirements and limitations govern the reimbursement of providers for the provision of services and items delivered to persons who are currently eligible for and accepted into one or more of the developmental disabilities services programs administered by the department. These requirements are in addition to any other federal and state requirements governing the funding and delivery of the various services provided through the program.

(2) Reimbursement for services and items is only available:

(a) through payments made to providers that have a current contract with the department authorizing the provider to deliver developmental disabilities services;

(b) for services and items that are authorized in rule or federal agreements for delivery through the particular developmental disabilities services program that the person is authorized by the DDP to participate in;

(c) when the particular services and items delivered are authorized for delivery to the person through the person's individual cost plan (ICP) as provided for in ARM 37.34.3002, or if the ICP is not applicable, the planning and authorization procedures applicable to the particular program;

(d) if the person has received the services and items authorized; and

(e) when delivered in accordance with applicable professional and facility licensing authorities.

(3) The contracted provider must be:

(a) currently enrolled in conformance with ARM 37.85.402 as a Montana Medicaid provider as evidenced by a signed current provider enrollment agreement, unless the type of provider is expressly exempted from the requirement by the department; and

(b) designated by the Developmental Disabilities Program (DDP) to be a qualified developmental disabilities provider, unless the program does not require the provision of the particular type of service or item by or through a qualified provider process.

(4) The department reimburses for a service or item at the lower of:

(a) the rate applicable to the particular service or item as established through rule; or

(b) the provider's usual and customary fee that is charged to any and all parties for the delivery of the service or item.

(5) Reimbursement for the delivery of a service or item delivered to a person through the department's DDP is payment in full and the provider may not receive further reimbursement for the service or item from the program, other departmental programs, or the person, or other parties.

(6) A provider in order to receive reimbursement for a service or item must properly invoice for the service or item through the DDP's electronic billing system unless the service or item is not reimbursed through that payment system.

(7) A provider may seek reimbursement from a person receiving services for a service or an item only if the service or item is not covered for Medicaid purposes and the billing is allowed for and conducted in accordance with ARM 37.85.406(11)(a).

(8) A provider may not seek or obtain reimbursement from the person for a service or item that, though reimbursable by the DDP as a service or item, has not been reimbursed by the program due to the failure of the provider to properly seek reimbursement for the service or item or due to the failure of the provider to properly deliver the service or item to the person.

(9) Reimbursement is not available for services and items:

(a) the DDP determines are not delivered in accordance with the quality assurance standards applicable to those services and items;

(b) provided while a person is a resident of an intermediate care facility for the developmentally disabled, an intermediate nursing care facility, or a skilled nursing care facility, as those facilities are defined in 50-5-101, MCA; or

(c) reimbursable as either a Medicaid state plan service or through any other local government, state, or federal program for which the person is eligible or would be eligible upon application.

(10) The department has the right to recover as a sum owing to the department reimbursement received by a provider that is an overpayment or is improperly obtained.

(11) Overpayments and improper payments include but are not limited to any departmental reimbursement obtained by a provider that:

(a) does not conform to the requirements and limitations of this rule or any other rules governing the administration and delivery of the services and items for which the reimbursement is obtained;

(b) does not compensate for actual delivery of the services and items for which the reimbursement is obtained;

(c) is the consequence of mistaken, improper, or fraudulent billing;

(d) is due to departmental mistake; or

(e) is due to other circumstances.

(12) The department or its agents may recover overpayments by any available means including withholding of further reimbursement payments.

(13) Reimbursement for services and items is not made directly to persons receiving DDP funded services.

(1) Authorization for the reimbursement to a provider for the delivery of particular services and items to a person receiving Developmental Disabilities Program (DDP) funded services is based on the implementation of an individual cost plan (ICP) for the person prior to the delivery of those services and items.

(2) Total reimbursement for the services and items delivered to a person may not exceed the sum designated for the person's fiscal year maximum in the person's ICP.

(3) For each service specified in a person's ICP, the total sum expended for the service may not exceed the sum designated as available for that service in the person's ICP.

(4) An ICP is developed by the person's case manager. For services reimbursed on time units the case manager estimates the levels of service delivery based on a reasonable assessment of the direct care staff time necessary to meet the health and safety needs of the person. The case manager uses the standardized reimbursement rates and any specified rates of reimbursement for particular services and items to calculate the amount of monies necessary to fund the services and items to be provided to the person.

(5) Neither the Montana resource allocation tool nor the plan of care may be used to authorize reimbursement for services or items.

(1) Reimbursement through the Developmental Disabilities Program's (DDP) Medicaid Home and Community-Based Services Waiver Programs is only available to a provider for services or items:

(a) delivered in accordance with the requirements and limitations of ARM 37.34.3001;

(b) delivered in accordance with the terms and conditions of the formal approval by the Centers for Medicare and Medicaid (CMS) governing each waiver program; and

(c) authorized in accordance with ARM 37.34.3002 for reimbursement through the person's individual cost plan (ICP).

(2) The department adopts and incorporates by this reference the rates of reimbursement for the delivery of services and items available through each Home and Community-Based Services Waiver Program as specified in the Montana Developmental Disabilities Program Services Manual, effective July 1, 2021. A copy of the manual may be obtained through the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and at http://dphhs.mt.gov/dsd/developmentaldisabililities/DDPratesinf.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.