Montana Administrative Register Notice 37-934 No. 24   12/24/2020    
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In the matter of the adoption of New Rules I and II and the amendment of ARM 37.87.903, 37.87.1401, 37.87.1402, 37.87.1407, 37.87.1408, and 37.87.1410 pertaining to home support services (HSS) program redesign










TO: All Concerned Persons


1. On November 6, 2020, the Department of Public Health and Human Services published MAR Notice No. 37-934 pertaining to the public hearing on the proposed adoption and amendment of the above-stated rules at page 2054 of the 2020 Montana Administrative Register, Issue Number 21.


2. The department has adopted New Rule I (37.87.1414) and New Rule II (37.87.1415) as proposed.


3. The department has amended the following rules as proposed: ARM 37.87.903, 37.87.1402, 37.87.1407, 37.87.1408, and 37.87.1410.


4. The department has amended the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:


            37.87.1401 HOME SUPPORT SERVICES AND THERAPEUTIC FOSTER CARE, SERVICES REIMBURSEMENT (1) through (3) remain as proposed.

(4) The HSS provider is reimbursed on a fee per unit of service basis. The two-hour weekly service requirement for HSS services must be met to be eligible for reimbursement. For purposes of this rule, a unit of service is based on a 15-minute unit increment. A unit of service is a period of 15 minutes as follows:

(a) through (h) remain as proposed.

(5) HSS rendered to youth residing in a Montana county with a per capita population of fewer than 6 people per square mile are eligible to receive a frontier community differential of 115% of the current fee schedule, as provided in ARM 37.85.106" target="RefRule">37.85.105.

           (5) remains as proposed but is renumbered (6).


5.  The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:


COMMENT #1: A commenter offered support for the proposed updated rules and belief that the proposed model will help providers serve youth and families with high intensity needs and prevent children from being moved out of the home.


RESPONSE #1: The department acknowledges this feedback and believes that the updated rules will enhance the quality of services provided to youth and families while managing a fiscally sound home support services (HSS) program.


COMMENT #2: A commenter recommended allowing unlimited HSS concurrently with residential treatment services, or alternatively to allow additional sessions four weeks prior to discharge from a residential facility to community services.


RESPONSE #2: The department's goal is to allow for a warm handoff period when the youth transitions from residential to community services. In response to this comment, the department will update the manual to allow for 96 HSS units to be billed concurrently with Therapeutic Group Home or Psychiatric Residential Treatment Facility services when provided for a warm handoff. The parent or guardian of the youth must be involved in the warm handoff process and weekly contact is required. The two-hour per week requirement will be waived for the warm handoff units. The 96 units will only be available when the youth is transitioning to a home or foster care. The manual is adopted in ARM 37.87.903 and the change in response to this comment is reflected in the manual.


COMMENT #3: A commenter raised concern that the two-hour HSS service requirement cannot be met during times of initiating or discharging from services and asked if the two-hour requirement is not met is the time billable.


RESPONSE #3: The department is not proposing any changes to this requirement for times of initiating or discharging from services, as the department considers the two-hour per week requirement a screening mechanism for families requiring this level of service and that two-hours per week is beneficial to the youth and youth's family during entrance and discharge from services. The two-hour per week service requirement must be met for reimbursement. The department will add clarifying language at ARM 37.87.1401(4) in response to this comment. The department is waiving the two-hour service requirement for the warm handoff period if the service is being provided concurrently while transitioning from residential treatment. The manual is adopted in ARM 37.87.903, and the change in response to this comment is reflected in the manual.


COMMENT #4: A commenter recommended increasing the per unit reimbursement rate from $18.50 per 15-minute unit to $22.50 per 15-minute unit to cover provider costs and incentivize providers to implement a new HSS program.


RESPONSE #4: The department has closely evaluated the proposed rates and the commenter's explanation for the requested increase. The department requested feedback from providers on the cost to provide HSS and feedback that was received was considered in rate development. The department believes that the assumptions, including wages, benefits, and productivity rates, used to develop the proposed rate of $18.50 per 15-minute unit are reasonable standards for a fiscally sound program. However, the department acknowledges that the service is more costly to provide in frontier areas of the state. To address the increased costs to provide services in frontier communities, the revised fee schedule will include a frontier differential payment of 115% of the proposed rate, resulting in a frontier rate of $21.28 per 15-minute unit. HSS services rendered to a youth residing in a Montana county with a per capita population of fewer than 6 people per square mile will be eligible to receive the frontier rate. The department has amended ARM 37.87.1401 to include the frontier differential, and the rate will be shown on the final fee schedule posted on the department's website.


COMMENT #5: A commenter inquired about including an ECSII qualification score for HSS.


RESPONSE #5: The department agrees with this recommendation and has included new language in the provider manual stating that a youth under the age of 6 must have an indication of stressors and vulnerabilities within the caregiver environment as indicated by a moderate score within Domain III of the ECSII to qualify for HSS. The manual is adopted in ARM 37.87.903, and the change in response to this comment is reflected in the manual.


            6. These rule adoptions and amendments are effective January 1, 2021.



/s/ Brenda K. Elias                                       /s/ Erica Johnston                                       

Brenda K. Elias                                            Erica Johnston, Interim Director

Rule Reviewer                                              Public Health and Human Services


Certified to the Secretary of State December 15, 2020.



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