(1) The department has established the Severe and Disabling Mental Illness, Home and Community Based Services waiver program for members who have severe and disabling mental illness, as defined in ARM 37.90.409, and who would otherwise have to reside in and receive Medicaid reimbursed care in a nursing facility.

(2) The department, in accordance with state and federal statutes, administrative rules, federal-state agreements governing the provision of the Medicaid funded home and community-based services delivered under this program, and within the available funding appropriated for the program, may determine within in its discretion:

(a) the types of services available through the program;

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

(c) the target population to be served through the program;

(d) the total number of members who may receive services through the program;

(e) delivery approach; and

(f) eligibility of members for the program.

(3) Enrollment in the program and the provision of services through the program are at the discretion of the department. There is no legal entitlement to enroll in the program or to receive any or all the services available through the program.

(4) The Severe and Disabling Mental Illness, Home and Community Based Services waiver program is referred to throughout this subchapter as "the SDMI HCBS waiver program" or "the waiver program."

(1) The services available through the waiver program are:

(a) adult day health, as defined in ARM 37.90.430;

(b) behavioral intervention assistant, as defined in ARM 37.90.436;

(c) case management, as defined in ARM 37.90.425;

(d) community transition services, as defined in ARM 37.90.415;

(e) consultative clinical and therapeutic services, as defined in ARM 37.90.418;

(f) environmental accessibility adaptations, as defined in ARM 37.90.409;

(g) health and wellness, as defined in ARM 37.90.417;

(h) homemaker chore, as defined in ARM 37.90.437;

(i) life coach, as defined in ARM 37.90.434;

(j) meals, as defined in ARM 37.90.446;

(k) non-medical transportation, as defined in ARM 37.90.450;

(l) pain and symptom management, as defined in ARM 37.90.416;

(m) personal assistance service, as defined in ARM 37.90.431;

(n) personal emergency response system, as defined in ARM 37.90.448;

(o) private duty nursing, as defined in ARM 37.90.447;

(p) residential habilitation, as defined in ARM 37.90.428, 37.90.429, 37.90.432, 37.90.460, and 37.90.461;

(q) respite care, as defined in ARM 37.90.438;

(r) specialized medical equipment and supplies, as defined in ARM 37.90.449; and

(s) supported employment, as defined in ARM 37.90.445.

(1) "Activities of daily living" means basic personal everyday activities.

(2) "Community First Choice (CFC) and Personal Assistance Service (PAS) Programs are programs designed to provide long term supportive care in a home setting.

(3) "Institutionalization" means placement in a nursing facility, a mental health nursing facility, or a state mental health hospital.

(4) "Instrumental activities of daily living" means household tasks which are limited to cleaning the area used by the member.

(5) "Level of care assessment" means a functional assessment used to determine if an individual requires the level of care normally provided in a nursing facility.

(6) "Level of impairment assessment" means an assessment used to identify areas in which a member requires long term services and supports.

(7) "Member" means an individual who is Medicaid eligible.

(8) "Mental health professional" means as defined in 53-21-102, MCA.

(9) "Quality improvement organization" means a group of health quality experts organized to improve the quality of care delivered to members.

(10) "Serious occurrence" means a significant event which affects the health, welfare, and safety of a member served in home and community-based services. The department has established a system of reporting and monitoring critical and non-critical incidents that involve members served by the program in order to identify, manage, and mitigate overall risk to the member. For information pertaining to reporting a serious occurrence, see the SDMI HCBS Policy #305, located at: https://dphhs.mt.gov/amdd/HCBSPolicyManual.

(11) "Severe and disabling mental illness" is defined in ARM 37.90.409.

(1) The waiver program services may only be provided by a provider that:

(a) is enrolled as a Montana Medicaid provider;

(b) meets all facility, licensing, and insurance requirements applicable to the services offered, the service settings provided, and the professionals employed; and

(c) meets the criteria as a qualified provider authorized to deliver the service as specified in the Provider Requirements Matrix for the SDMI HCBS waiver program. The department adopts and incorporates by reference the Provider Requirements Matrix for the SDMI HCBS waiver program, dated July 1, 2020, and located at: https://dphhs.mt.gov/amdd/HCBSPolicyManual.

(2)  A provider of services must ensure that the services adhere to the requirements of 42 CFR 441.301(c)(4), which permits reimbursement with Medicaid monies only for services within settings that meet certain qualities set forth under the regulation. These qualities include that the setting:

(a)  is integrated in and facilitates full access of the individual to the greater community;

(b)  ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid Home and Community-Based Services;

(c) is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting;

(d) ensures the individual's rights of privacy, dignity, and respect, and freedom from coercion and restraint;

(e) supports health and safety based upon the individual's needs, decisions, or desires;

(f) optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including, but not limited to daily activities, physical environment, and with whom to interact;

(g)  provides an opportunity to seek employment and work in competitive integrated settings; and

(h) facilitates individual choice of services and supports, and who provides them.

(3) The department may authorize a SDMI HCBS contracted case management entity to issue pass-through payment for reimbursement of services rendered by a non-Medicaid provider for the following services:

(a) community transition;

(b) environmental accessibility adaptations;

(c) health and wellness;

(d) homemaker chore;

(e) meals; and

(f) specialized medical equipment and supplies.

(4) A provider must document the completion of required training in the personnel file of the staff or in the provider's staff training files which includes:

(a) title of the training;

(b) the date of the training;

(c) name and title of the trainer;

(d) type or topic of the training;

(e) the agenda of the training;

(f) the hours of the training; and

(g) the signature and date of the staff who received the training.

(5) Providers must ensure that direct care staff are trained and capable of providing waiver program services.

(6) The department adopts and incorporates by reference 42 CFR 441.301(c)(4), as amended January 16, 2014.  A copy of this regulation may be obtained at https://www.ecfr.gov/ or by contacting the Department of Public Health and Human Services, Behavioral Health and Developmental Disabilities Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905.

(1) The department adopts and incorporates by reference the Medicaid Home and Community-Based Services for Adults with Severe and Disabling Mental Illness fee schedule. Unless otherwise provided for in rule, the provider reimbursement rate for waiver program services is stated in the department's fee schedule as provided in ARM 37.85.105(5)(b). These fees are calculated based on:

(a) the biennial legislative appropriation; and

(b) the estimated demand of covered services during the biennium.

(2) Medicaid reimbursement for the SDMI HCBS waiver program will be the lesser of:

(a) the provider's usual and customary charge for the service; or

(b) the rate established in the department's Medicaid fee schedule adopted and incorporated into ARM 37.85.105(5)(b).

(3) The SDMI HCBS waiver program is the payor of last resort and will not reimburse a service that otherwise is or should be paid by another source.

(4) The SDMI HCBS waiver program will not reimburse for services provided to individuals of a member's household or family.

(1) To qualify for the SDMI HCBS waiver program, a member must:

(a) be 18 years of age or older;

(b) have a minimum of three areas of high-level impairment indicated by a score of three or higher on the Severe and Disabling Mental Illness, Home and Community-Based Waiver, Evaluation and Level of Impairment form; and

(c) have experienced one of the following in the previous 12 months:

(i) involuntarily committed because of a mental disorder to the Montana State Hospital or the Montana Mental Health Nursing Care Center for at least 30 consecutive days; or

(ii) diagnosed with one of the diagnoses in (2), excluding mild or not otherwise specified.

(2) The following qualify as a severe and disabling mental illness diagnosis:

(a) Schizophrenia, paranoid type;

(b) Schizophrenia, disorganized type;

(c) Schizophrenia, catatonic type;

(d) Schizophrenia, undifferentiated type;

(e) Schizophrenia, residual type;

(f) Delusional disorder;

(g) Schizoaffective disorder;

(h) Schizoaffective disorder, depressive type;

(i) Bipolar I disorder, manic, moderate;

(j) Bipolar I disorder, manic, severe without psychotic features;

(k) Bipolar I disorder, manic, severe with psychotic features;

(l) Bipolar I disorder, depressed, moderate;

(m) Bipolar I disorder, depressed, severe without psychotic features;

(n) Bipolar I disorder, depressed, severe with psychotic features;

(o) Bipolar I disorder, mixed, moderate;

(p) Bipolar I disorder, mixed, severe without psychotic features;

(q) Bipolar I disorder, severe with psychotic features;

(r) Bipolar II disorder;

(s) Major depressive disorder, single, moderate;

(t) Major depressive disorder, single, severe without psychotic features;

(u) Major depressive disorder, single, severe with psychotic features;

(v) Major depressive disorder, recurrent, moderate;

(w) Major depressive disorder, recurrent, severe without psychotic features;

(x) Major depressive disorder, recurrent, severe with psychotic features;

(y) Post traumatic stress disorder, acute;

(z) Post traumatic stress disorder, chronic;

(aa) Generalized anxiety disorder; and

(ab) Borderline personality disorder.

(1) A member is eligible for enrollment in the program if the member meets the following criteria:

(a) is at least 18 years of age;

(b) is Medicaid eligible;

(c) requires the level of care (LOC) of a nursing facility as determined by the Quality Improvement Organization under contract with the department;

(d) meets the severe and disabling mental illness criteria at ARM 37.90.409; and

(e) meets the level of impairment criteria established in the waiver program Evaluation and Level of Impairment (LOI) form, as determined by a licensed mental health professional, by scoring a three or higher on at least two areas.

(2) Once a member is found eligible to receive waiver program services, the member is referred to the appropriate case management team. The case management team:

(a) offers the member an available opening for program services if one is available; or

(b) places the member on the wait list for an available opening.

(3) A member is placed on the wait list in the service areas the member selects.

(4) The case management team must use the member's combined LOC and LOI score to determine the member's score for placement on the wait list.

(5) If more than one member has the same combined wait list score, then each member is placed on the wait list based upon the member's wait list score as determined in (4), and thereafter on a first-come, first-served basis.

(6) A member may be removed from the SDMI HCBS waiver program for the following reasons:

(a) a determination by a mental health professional that the member no longer meets the eligibility criteria;

(b) the member does not select and actively participate in at least two services in the waiver program within 45 calendar days from the date the member agrees to and signs the PCRP;

(c) the department determines that the member has failed to utilize or attempted to utilize at least two waiver services, in over 90 days, with repeated attempts documented by the case management team to engage the member; and

(d) the member no longer requires the level of care of a nursing facility as determined by the Quality Improvement Organization under contract with the department.

(7) Eligibility for consideration for the waiver program does not entitle an individual for selection and entry into the program.

(1) A Person-Centered Recovery Plan (PCRP) is a written plan that identifies the supports and services that are necessary for the member to remain out of institutional level of care, allow the member to function at the member's maximum capacity, and achieve personal goals towards recovery. 

(2) All services must be specifically authorized in writing in the member's PCRP.

(3) Each PCRP must be developed, reviewed, and revised by the case management team. The case management team must:

(a) initiate the development of the PCRP upon the member's enrollment into the SDMI HCBS waiver program;

(b) have monthly telephone contact with the member;

(c) review the PCRP quarterly with the member in the member's residence, place of service, or other appropriate setting, and update the PCRP if there are any changes to the information listed in (5)(a) through (j); and

(d) complete an annual review of the PCRP with the member and update the PCRP if there are any changes to the information listed in (5)(a) through (j).

(4) The case management team must develop the PCRP in consultation with:

(a) the member or the member's legal representative;

(b) the member's treating and other appropriate health care professionals; and

(c) others who have knowledge of the member's needs.

(5) The PCRP must include:

(a) the primary SDMI diagnosis and any other diagnosis of the member that are relevant to the services provided;

(b) the member's symptoms, complaints, and complications indicating the need for services;

(c) the member's strengths, areas of concern, goals, objectives, and required interventions;

(d) the SMDI HCSB waiver program services that will be provided;

(e) all other services the member requires including Montana Medicaid state plan services and community-based services and supports; however, including non-program services in the PCRP does not obligate the department to pay for the non-program services or ensure their delivery or quality;

(f) a description of how each service addresses each of the member's functional needs outlined in the Severe and Disabling Mental Illness, Home and Community Based Services, Evaluation and Level of Impairment form;

(g) a crisis plan;

(h) physicians' orders;

(i) a discharge plan;

(j) the projected annual cost of SDMI Home and Community-Based Services (HCBS) waiver program services provided;

(k) the signature of the member or the member's legal representative which signifies the participation in and agreement of the PCRP; and

(l) the names and signatures of all individuals who participated in the development of the PCRP which signifies the participation in and agreement of the PCRP.

(6) The case management team must provide a copy of the plan to the recipient.

(7) The case management team must retain all of the member's records in accordance with ARM 37.85.414.

(1) In order to maintain the program cost within the appropriated federal and state funds, the cost of a member's Person-Centered Recovery Plan (PCRP) may be limited by the department.

(2) The total annual cost of services for each member, except as approved by the department, may not exceed a maximum amount set by the department.

(3) The department may limit the services members receive under the waiver program based upon the appropriation of funding by the legislature.

(4) The cost of services in the PCRP must be determined prior to implementation of the PCRP and may be revised as necessary by the department or the department's designee.

(1) Environmental accessibility adaptations are modifications to a member's home that are necessary to increase accessibility, independence, and prevent the need for a higher level of care.

(2) The member's need for the adaptation must be documented by an individual with the appropriate licensure, certification, or experience with home modification to document the member's need for the adaptation to increase accessibility, independence, and prevent the need for a higher level of care.

(3) The provision of environmental accessibility adaptations may include the provision of consultation regarding the appropriateness of the equipment or supplies.

(4) The waiver program does not cover:

(a) additions to the square footage of the home;

(b) services that are for comfort or convenience;

(c) services that are not a direct and specific benefit for the member; and

(d) services that are for maintenance, repair, or building code compliance that is the responsibility of the homeowner.

(5) Environmental accessibility adaptations must:

(a) ensure the health, welfare, and safety of the member in their home; and

(b) allow the member to function with greater independence in their home.

(6) Environmental accessibility adaptations must be provided in accordance with applicable state and local building codes by individuals licensed through the Montana Department of Labor and Industry to do home modifications.

(1) Community transition services are nonrecurring set-up expenses for members who are transitioning from an institutional setting into a community living setting or a private residence and are necessary to coordinate and purchase to establish a basic household.

(2) The department may approve community transition services on a case-by-case basis from other settings in circumstances that address a member's health or safety.

(3) The case management team must complete a needs assessment prior to implementation of the service.

(4) The needs assessment must demonstrate community transition services are required to:

(a) address a health or safety concern; and

(b) discharge from or avert institutionalization.

(5) Allowable expenses are those necessary to enable a person to establish a basic household and may include:

(a) customary security deposits that are required to obtain a lease on an apartment or home;

(b) essential household items;

(c) moving expenses incurred directly from the moving, transport, provision, or assembly of household furnishings for the residence;

(d) customary setup fees or deposits for utility or service access, including telephone landline or cell phone, electricity, heating, and water;

(e) services necessary for a member's health and safety; and

(f) fees associated with obtaining legal or identification documents necessary for housing applications.

(6) Community transition services do not include monthly rental or mortgage expenses, food, and diversion/recreational expenses.

(7) Refunded security deposits must be paid to the department.

(1) Pain and symptom management is defined as a service that provides traditional and nontraditional methods of pain reduction or management.

(2) Allowable non-traditional or mind-body therapies include:

(a) acupuncture;

(b) reflexology;

(c) massage therapy;

(d) craniosacral therapy;

(e) hypnosis;

(f) biofeedback; and

(g) pain mitigation counseling/coaching.

(3) Allowable traditional therapies include:

(a) chiropractic therapy; and

(b) nursing services by a nurse specializing in pain and symptom management.

(4) The service must be prescribed by a licensed health care professional.

(5) The service must be documented in the member's Person-Centered Recovery Plan and:

(a) address the member's chronic or acute symptoms, complaints, or complications indicating the need for services;

(b) include the number of authorized sessions; and

(c) document the expected outcomes of the provision of the service.

(6) Services must be provided by a person licensed or certified to provide the service.

(1) Health and wellness services are services that assist a member in acquiring, retaining, and improving self-help, socialization, and adaptive skills to reside successfully in the community.

(2) The services include:

(a) classes on weight loss, smoking cessation, and healthy lifestyles;

(b) health club memberships and exercise classes;

(c) art, music, and dance classes;

(d) costs associated for participating in adaptive sports and recreational activities;

(e) classes on managing disabilities; and

(f) hippotherapy.

(3) The service must be prescribed by a licensed health care professional.

(4) The service must be documented in the member's Person-Centered Recovery Plan and:

(a) address the member's symptoms, complaints, or complications indicating the need for services;

(b) include the number of authorized sessions; and

(c) document the expected outcomes of the provision of the service.

(5) Services may be provided in a setting appropriate to the provision of the service.

(1) Consultative clinical and therapeutic services provide comprehensive expertise, training, and technical assistance to improve the ability of providers and caregivers to carry out therapeutic interventions and reduce challenges that may be interfering with a member's daily functioning, independence, and quality of life.

(2) Consultative clinical and therapeutic services include:

(a) a clinical/functional evaluation;

(b) implementation of positive behavioral supports as part of the member's Person-Centered Recovery Plan (PCRP);

(c) training and technical assistance for the member's paid and non-paid caregivers to implement the positive behavioral supports; and

(d) monitoring the member's response to the positive behavioral supports and updating the PCRP if necessary.

(3) Consultative clinical and therapeutic services must meet a documented behavioral need that cannot be addressed through other waiver or state plan services.

(4) Consultative clinical and therapeutic services may be provided by a:

(a) psychiatrist;

(b) psychologist;

(c) neuropsychiatrist;

(d) licensed clinical professional counselor; or

(e) licensed clinical social worker.

(5) Training must be aimed at assisting the provider and caregiver in meeting the needs of the member and must include instruction to implement the positive behavioral supports outlined in the member's PCRP.

(1) Homemaker chore services are extensive cleaning beyond the scope of general household cleaning under Community First Choice/Personal Assistance Service (CFC/PAS) state plan and is needed to return a residence to a sanitary and safe environment.

(2) Homemaker chore may be provided by:

(a) entities that provide deep cleaning, yard, trash removal, and moving services;

(b) home health providers; and

(c) CFC/PAS providers.

(3) Homemaker chore is provided when neither the member nor other community resources are available to provide the service.

(4) Moving expenses must be prior authorized by the department.

(1) The department provides written notice to a member when a determination is made by the department concerning:

(a) Medicaid eligibility;

(b) eligibility for the SDMI HCSB waiver program; and

(c) changes to a member's Person-Centered Recovery Plan (PCRP).

(2) The department provides a member with notice ten working days before termination of services due to a determination of ineligibility.

(3) Requirements for administrative review and fair hearings are provided for in ARM Title 37, chapter 5, subchapter 3.

(1) Case management means case management as defined at the Code of Federal Regulations (CFR) at 42 CFR 440.169(d)(e).

(2) Case management services offered under the Severe and Disabling Mental Illness, Home and Community Based waiver program are provided through a selective contract for conflict free case management under the authority of a 1915(b)(4) waiver authorized under Section 1915(b) of the Social Security Act.

(3) A case management team must consist of:

(a) a registered nurse or a licensed practical nurse, with experience on a case management team serving members through a program of home and community-based services for the elderly and persons with physical disabilities, or severe and disabling mental illness; and

(b) a social worker with a bachelor's degree and two consecutive years' experience providing case management services to adults with severe and disabling mental illness.

(1) Meal service is the provision of hot or cold meals to a member up to twice daily.

(2) Meals may be provided by:

(a) a non-profit entity or public agency that provides congregate or home-delivered meals on a regular basis to individuals who are unable to gain access to meals due to age or disability;

(b) entities that provide home-delivered meals that are transported from a preparation site to the member's residence; or

(c) meal preparation entities.

(3) Members must need special assistance to ensure adequate nutrition due to:

(a) special nutritional needs; or

(b) the member's inability to gain access to proper nutrition due to a disability.

(4) The provider must follow the rules that govern the provision of meal services at ARM 37.41.306 through 37.41.315.

(5) If meals are provided during the provision of another service, the total combined meals provided to the member may not exceed two meals per day.

This rule has been repealed.

This rule has been repealed.

(1) Adult day health is a supervised daytime program that offers health and social services for adults with severe and disabling mental illness to ensure optimal functioning of the member and enrichment activities through engaging social community but who do not require the intervention or services of a registered nurse or licensed rehabilitative therapist onsite.

(2) An entity providing adult day health services must be licensed as an adult day care center as provided at ARM 37.106.301, et seq.

(3) Adult day health services are furnished in an outpatient setting that does not include overnight residential services.

(4) Adult day health includes the following service components:

(a) meals as described in ARM 37.106.2616;

(b) health, nutritional, recreational, and social habilitation; and

(c) transportation between the member's place of residence and the adult day health center.

(1) Personal assistance service (PAS) is the provision of long term service and supports in a member's home and in the community tailored to each member's needs and living situation.

(2) PAS may be provided by:

(a) a home health agency provider;

(b) a community first choice/personal assistance service (CFC/PAS) provider; or

(c) a member self-directing the service, as described in ARM 37.90.439.

(3) PAS may be provided only when the services available in CFC/PAS are insufficient to meet the following needs of the member:

(a) the member has a documented physical need that requires hours in addition to the 42 bi-weekly hours available under CFC/PAS; or

(b) the member requires services outside of their residence that cannot be provided by CFC/PAS.

(4) PAS may not be provided in a residential habilitation.

(5) PAS includes the following service components:

(a) activities of daily living;

(b) instrumental activities of daily living; and

(c) non-medical transportation.

This rule has been repealed.

(1) Behavioral Intervention Assistant service is provided when the personal assistance services available in the waiver and state plan are insufficient in meeting the needs of the member due to challenging behaviors and assistance is required to improve or restore function in activities of daily living (ADL), instrumental activities of daily living (IADL), or social and adaptive skills.

(2) Behavioral intervention assistant service is provided by entities that are licensed and insured to deliver personal care services.

(3) Behavioral intervention assistants must have at least eight hours of specialized behavioral health training annually that is approved by the department.

(4) Behavioral intervention assistants provide instructive assistance, cueing to prompt, and supervision to assist the member in completion of ADLs, IADLs, and community integration activities.

(1) Life coach focuses on social determinants of health (SDoH) that impact a member's overall health and well-being and addresses the obstacles that impede a member's progress towards self-sufficiency, improved health, and well-being. 

(2) Life coach services may be provided by:

(a) independent living centers;

(b) home health agencies; and

(c) other entities approved by the department.

(3) Life coaches must have at least eight hours of specialized behavioral health training annually approved by the department.

(4) A member must have a SDoH assessment with identified needs and established goals in their Person-Centered Recovery Plan.

(5) Life coach services must include at least one of the following social determinants of health:

(a) economic stability;

(b) neighborhood and physical environment;

(c) education;

(d) regular and consistent access to healthy foods, education on nutrition, and overall health impacts;

(e) access to needed healthcare; and

(f) community and social context.

(6) Life coach services may not duplicate services provided under behavioral intervention assistant.

(1) Supported employment services assist members to prepare for, find, and keep competitive jobs that exist in the open labor market, pay at least minimum wage, and are in a variety of integrated work settings. 

(2) Supported employment services are provided by public or private employment agencies, Independent Living Centers, organizations that provide support for individuals with disabilities, Mental Health Centers, or a self-employed individual with at least:

(a) an associate degree in vocational rehabilitation, career development, or disability services;

(b) an Individual Placement Services (IPS) certification; or

(c) two years of experience in vocational rehabilitation, career development, or disability services and receive an IPS certification within six months of hire.

(3) A supported employment provider must have at least eight hours of specialized behavioral health training annually approved by the department.

(4) Supported employment services are for members who have previously been unable to succeed in competitive employment due to significant disabilities or challenging behaviors and need intensive, ongoing job supports to maintain long-term employment.

(5) The need for supported employment must be documented in the member's Person-Centered Recovery Plan and individualized to meet the identified need.

(6) Supported employment may:

(a) continue for as long as the member wants and needs support; and

(b) be provided in conjunction with other employment services.

(7) Supported employment may be provided only in a competitive employment setting.

This rule has been repealed.

This rule has been repealed.

(1) Respite care is planned or emergency care provided to a member with need for support and supervision in order to provide temporary relief to the unpaid caregiver of the member.

(2) Respite care services may be provided in:

(a) a member's place of residence;

(b) an alternative private residence; or

(c) a residential habilitation setting or a nursing facility.

(3) Respite care is provided for members who:

(a) in the absence of respite care, would require institutional level of care;

(b) are unable to care for themselves; and

(c) have an unpaid caregiver as the member's primary caregiver.

(4) A person providing respite care services must be:

(a) physically and mentally qualified to provide this service to the member;

(b) aware of emergency assistance systems and CPR-certified; and

(c) able to follow the positive behavioral supports that are in place.

(5) A person who provides respite care services to a member may be required by the case management team to have the following when the member's needs so warrant:

(a) knowledge of the physical and mental conditions of the member;

(b) knowledge of common medications and related conditions of the member; and

(c) ability to administer basic first aid.

(1) Self-directed services may only be provided by an agency.

(2) Services may be directed by:

(a) a member who has the capacity to self-direct, as determined by the department or the department's designee;

(b) a legal representative of the member, including a parent, spouse, or legal guardian; or

(c) a nonlegal representative freely chosen by the member or his/her legal representative.

(3) The person directing the services must:

(a) be 18 years of age or older;

(b) successfully complete required training for self-direction; and

(c) if acting in the capacity of a representative demonstrate understanding of the member's needs and preferences.

(4) The case management teams must:

(a) refer member to the department's designee for a functional capacity evaluation; and

(b) assist the member to develop an emergency backup plan, identifying and mitigating risks or potential risks, and monitor the health and safety of the member.

(5) Members must:

(a) be capable of making choices about activities of daily living, understand the impact of their choices, and assume responsibility for those choices;

(b) be capable of managing all tasks related to service delivery including recruiting, hiring, scheduling, training, directing, and dismissal of attendants; and

(c) understand the shared responsibility between the member and the provider agency.

(6) The provider agency must:

(a) advise, train, and support the member, as identified in the member's Person-Centered Recovery Plan;

(b) assist with recruiting, interviewing, hiring, training, managing, paying, and dismissing workers; and

(c) monitor health and welfare of the member.

(7) Self-directed services can be terminated when:

(a) the member chooses not to self-direct; or

(b) the case management team or the department identifies an instance where the self-directed option is not in the best interest of the member; and

(c) a corrective action does not improve the situation.

(8) The member must be informed in writing of the plan to transfer to an agency-based service delivery.

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) Private duty nursing are medically necessary nursing services delivered to a member in their place of residence.

(2) Private duty nursing may be provided by:

(a) a licensed registered nurse (RN); or

(b) a licensed practical nurse (LPN) under the supervision of a RN, physician, dentist, osteopath, or podiatrist authorized by the state of Montana to prescribe medication.

(3) Private duty nurses may be employed by a home health care provider or self-employed.

(4) Private duty nursing may be provided when Home Health Agency services under state plan, defined in ARM 37.40.701, are not appropriate or available.

(5) Private duty nursing must be prescribed by an appropriately licensed medical professional.

(6) Private duty nurses must comply with the Montana Nurse Practice Act.

(1) A personal emergency response system (PERS) is an electronic device used to secure assistance in an emergency situation to allow a member to gain greater independence. 

(2) A PERS must be connected to an emergency response unit with the capacity to activate emergency personnel.

(3) The provision of a personal emergency response system as a service does not include the purchase, installation, or routine monthly charges of a telephone.

(1) Specialized medical equipment and supplies is the provision of items of medical equipment and supplies to a member for the purpose of maintaining and improving the member's ability to reside at home and to function in the community.

(2) Specialized medical equipment and supplies must:

(a) be functionally necessary and relate specifically to the member's disability;

(b) substantively meet the member's needs for accessibility, independence, health, or safety;

(c) be likely to improve the member's functional ability or the ability of a caregiver or service provider to maintain the member in the member's home; and

(d) be the most cost-effective item that can meet the needs of the member.

(3) Specialized medical equipment and supplies services do not include:

(a) items used for leisure and recreational purposes only;

(b) items of clothing;

(c) basic household furniture; or

(d) educational items including computers, software, and books unless such items are purchased in conjunction with an environmental control unit.

(4) A service animal is an animal trained to undertake particular tasks on behalf of a member that the member cannot perform and that are necessary to meet the member's needs for accessibility, independence, health, or safety.

(5) A service animal does not include any of the following:

(a) pets, companion animals, and social therapy animals;

(b) guard dogs, rescue dogs, sled dogs, tracking dogs, or any other animal not specifically designated as a service animal; or

(c) wild, exotic, or any other animals not specifically supplied by a training program on the approved provider list.

(6) Supplies necessary for the performance of a service animal to meet the specific needs of the member are allowable expenses. Supplies do not include food to maintain the service animals.

(7) Care necessary to the health and maintenance of a service animal include veterinarian care, transportation for veterinarian care, license, registration, and where the member or member's primary care giver is unable to perform it, grooming.

(8) Certain items of medical equipment or supplies for short term use, as specified by the department, may be leased or rented instead of purchased.

(9) The department may require a consultation prior to the purchase of certain equipment and supplies.

(1) Nonmedical transportation is the provision to a member of transportation through common carrier or private vehicle for access to social or other nonmedical activities.

(2) Nonmedical transportation services are provided only after volunteer transportation services, or transportation services funded by other programs, have been exhausted.

(3) Nonmedical transportation may be provided by accessible transportation providers, cabs, personal care provider agencies, and Life Coaches. Nonmedical transportation providers must show proof of:

(a) a valid Montana driver's license; and

(b) adequate automobile insurance.

(4) Nonmedical transportation services must be:

(a) provided by the most cost-effective mode; and

(b) provided only after all volunteer, state plan, or other publicly funded transportation programs have been exhausted or determined inappropriate.

(5) Nonmedical transportation services are available only for the transport of members to and from activities identified in the member's Person-Centered Recovery Plan.

(1) Residential habilitation, assisted living, provides 24-hour services and supports designed to ensure the health, safety, and welfare of a member and assist the member acquiring and improving behaviors necessary to live and participate in the community.

(2) Assisted living facilities must be licensed in accordance with ARM Title 37, chapter 106, subchapter 28.

(3) Assisted living includes the following service components:

(a) personal care;

(b) social and recreational activities;

(c) medication management and oversite;

(d) medical escort;

(e) non-medical transportation;

(f) meals; and

(g) 24-hour onsite awake staff.

(4) A provider of adult residential care must report serious occurrences, as defined in ARM 37.90.403, to the department.

(1) Residential habilitation, intensive mental health group home, provides 24-hour care designed to ensure the health, safety, and welfare of a member and provide supervision for the member to live and participate in the community.

(2) Intensive mental health group homes must be licensed in accordance with ARM Title 37, chapter 106, subchapter 19.

(3) Only the Montana State Hospital, the Montana Mental Health Nursing Care Center, or the Addictive and Mental Disorders Division may refer a member for intensive mental health group home services under the waiver program.

(4) An intensive mental health group home must:

(a) be a licensed mental health center with a group home endorsement;

(b) be approved by the Addictive and Mental Disorders Division; and

(c) be knowledgeable about commitment and recommitment processes, as well as the process for use of involuntary medications.

(5) Intensive mental health group homes consist of the following staff:

(a) a program supervisor, .5 FTE, who provides clinical supervision as described in the member's Person-Centered Recovery Plan;

(b) a residential manager, 1.0 FTE; and

(c) 24 hour onsite awake staff with at least a 1:3 staffing ratio for at least 16 hours per day during awake hours and at least one staff for eight hours during sleeping hours, as determined by the provider.

(6) The member must:

(a) have a history of repeated unsuccessful placements in less intensive community-based programs;

(b) have at least one full year combined of institutionalization within the past three years; and

(c) exhibit an inability to perform activities of daily living in an appropriate manner due to the member's Severe and Disabling Mental Illness (SDMI) diagnosis.

(7) Intensive mental health group homes must offer the following service components:

(a) assistance with activities of daily living and instrumental activities of daily living, as needed;

(b) medication management, administration, and oversite;

(c) medical escort;

(d) crisis stabilization services as needed by the member;

(e) close supervision and support of daily living activities;

(f) access to community involvement;

(g) care coordination;

(h) discharge planning; and

(i) transportation and supervision, if appropriate, to suitable community resources.

(8) A provider of adult residential care must report serious occurrences, as defined in ARM 37.90.403, to the department.

(1) Residential habilitation, mental health group home, provides 24 hours of available services and supports designed to ensure health, safety, and welfare of a member and assist the member in the acquisition and improvement of behaviors necessary to live and participate in the community.

(2) A mental health group home must be a licensed mental health center with a group home endorsement.

(3) Mental health group homes consist of the following staff:

(a) a program supervisor, .5 FTE, who provides clinical supervision as determined in the member's Person-Centered Recovery Plan;

(b) a residential manager, 1.0 FTE; and

(c) 24-hour onsite awake staff with a minimum 1:4 staffing ratio for at least 16 hours per day during awake hours and at least one staff for eight hours during sleeping hours, as determined by the provider.

(4) The member must have:

(a) a history of repeated unsuccessful placements in less intensive rehabilitative community-based programs;

(b) impaired interpersonal or social functioning;

(c) impaired occupational functioning;

(d) impaired judgment;

(e) poor impulse control; or

(f) a lack of family or other community or social supports.

(5) The member must exhibit:

(a) an inability to perform activities of daily living in an appropriate manner due to the member's SDMI diagnosis; and

(b) symptoms related to the SDMI severe enough that a less intensive level of service would be insufficient to support the member in an independent living environment and requires a structured treatment environment to be successfully treated in a less restrictive setting.

(6) Mental health group homes must offer the following service components:

(a) assistance with activities of daily living and instrumental activities of daily living as needed;

(b) medication management, administration, and oversite as needed;

(c) medical escort;

(d) crisis stabilization services as needed by the member;

(e) supervision and support of daily living activities;

(f) assistance with medications, including administration of medications as necessary;

(g) skills building in areas of community reintegration and independent living;

(h) care coordination;

(i) discharge planning for transition to a less restrictive setting; and

(j) transportation and supervision, if appropriate, to suitable community resources.

(7) A provider of adult residential care must report serious occurrences, as defined in ARM 37.90.403, to the department.

(1) Residential habilitation, adult group home, provides 24-hour available services and supports designed to ensure health, safety, and welfare of a member and assist the member in the acquisition and improvement of behaviors necessary to live and participate in the community.

(2) An adult group home must be provided in the setting as defined in ARM Title 37, chapter 88, subchapter 9.

(3) Placement in an adult group home must be supported by the member's level of impairment and strengths assessment found in the Person-Centered Recovery Plan.

(4) Adult group home is a bundled service that includes:

(a) personal care;

(b) homemaker services;

(c) social activities;

(d) recreational activities;

(e) medication management and oversite;

(f) medical escort;

(g) nonmedical transportation; and

(h) 24-hour onsite awake staff to meet the needs of the members and provide supervision for safety and security.

(5) Members in an adult group home may not receive the following services under the Home and Community Based Services, Adults with Severe and Disabling Mental Illness Waiver Program:

(a) personal assistance;

(b) homemaker chore;

(c) respite care;

(d) environmental accessibility adaptations; or

(e) meals.

(1) Residential habilitation, foster care, provides 24-hour services and supports designed to ensure the health, safety, and welfare of a member and assist the member in acquiring and improving behaviors necessary to live and participate in the community.

(2) Residential habilitation, foster care, must be licensed in accordance with ARM Title 37, chapter 106, subchapter 20.

(3) Residential habilitation, foster care, includes the following components:

(a) personal care;

(b) social activities;

(c) recreational activities;

(d) medication management and oversite;

(e) medical escort;

(f) nonmedical transportation;

(g) meals; and

(h) 24-hour on-site supervision to meet the needs of the member for safety and security.

This rule has been repealed.

This rule has been repealed.