BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
TO: All Concerned Persons
1. On August 26, 2022, at 1:00 p.m., the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider the proposed amendment of the above-stated rules. Interested parties may access the remote conferencing platform in the following ways:
(a) Join Zoom Meeting at: https://mt-gov.zoom.us/j/81363956685?pwd=TWZzeWlRRnNJWUZaZW94NnF4RVkydz09, Meeting ID: 813 6395 6685, and Password: 607667; or
(b) Dial by telephone +1 646 558 8656, Meeting ID 813 6395 6685, and Password: 607667. Find your local number: https://mt-gov.zoom.us/u/kb0f5Xqfhm.
2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact the Department of Public Health and Human Services no later than 5:00 p.m. on August 12, 2022, to advise us of the nature of the accommodation that you need. Please contact Kassie Thompson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail email@example.com.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
GRANTS TO COUNTIES, GOALS AND OUTCOMES CRISIS DIVERSION GRANTS, PURPOSE (1) A county or group of counties may apply to the department for a grant under this subchapter. Crisis Diversion Grants, as provided under Title 53, chapter 21, part 12, MCA, provide funding to eligible county and federally recognized tribal governments to support the implementation of community-based jail diversion, crisis intervention services, and short-term inpatient treatment services for individuals with mental illness. The grants are in the form of matching state funds awarded based on criteria set forth in 53-21-1203, MCA.
(2) In developing grant applications, counties should consider the following goals:
(a) to reduce reliance on admissions to Montana State Hospital (MSH) for emergency and court ordered detention and evaluation;
(b) to support the treatment of mental illness closer to home by increasing local treatment capacity and creating better treatment outcomes;
(c) to increase the number of intervention and jail diversion options that may provide judges, county attorneys, and law enforcement with alternatives to incarceration; and
(d) to establish and support collaboration among community stakeholders to address community needs.
(3) The department expects grant applications to address the following outcomes:
(a) disruption of the consumer's life will be minimized and the effectiveness of treatment will be maximized, resulting in better treatment outcomes;
(b) financial and other resources will be retained in the community for jail diversion and crisis intervention; and
(c) inpatient capacity at MSH will be appropriately utilized.
AUTH: 53-21-1202, 53-21-1203, MCA
IMP: 53-21-1203, MCA
GRANTS TO COUNTIES CRISIS DIVERSION GRANTS, APPLICATION AND PARTICIPANTS (1) Only a county as defined in ARM 37.2.902 or a group of counties that have collaborated for the purpose established in 53-21-1203, MCA, may submit a grant application for matching fund grants awarded under this subchapter. At the beginning of the program's funding cycle, the department will issue a request for proposal (RFP) describing the program requirements, evaluation criteria, and eligibility criteria for award of Crisis Diversion Grant funding.
A county or group of counties preferring to have a chief operating officer or other person submit a grant application may issue a document authorizing the chief operating officer or other person to act on their behalf. The authorization document must be included with the grant application. The following entities may submit an application for Crisis Diversion Grants awarded under this subchapter:
(a) a county government as defined in ARM 37.2.902;
(b) a federally recognized tribal government; or
(c) any combination of (a) and (b).
Funds will be distributed only to a county or group of counties via a contract approved by the department. Counties must submit invoices to the department for funds. A county or group of counties that includes tribal lands must demonstrate coordination efforts with tribal representatives to be eligible for Crisis Diversion Grants.
(4) The department will evaluate applications as set forth in the RFP and determine eligibility for a Crisis Diversion Grant. Counties and federally recognized tribal governments who the department determines are eligible for grants must enter into a contract with the department to receive the funding award.
AUTH: 53-21-1203, MCA
IMP: 53-21-1203, MCA
GRANTS TO COUNTIES CRISIS DIVERSION GRANTS, DETERMINING GRANT AMOUNTS (1) The department will base matching fund grants Crisis Diversion Grants awarded under this subchapter on the criteria specified in 53-21-1203, MCA.
(2) The total amount of
matching fund grants Crisis Diversion Grants will not exceed available funding appropriated by the Montana Legislature.
The department will evaluate each county or multicounty grant application submitted pursuant to ARM 37.89.1009 and award matching fund grants based on the likelihood, as determined by the department, that the plan would promote appropriate utilization of the Montana State Hospital (MSH) for emergency and court-ordered detention and evaluation and would ultimately result in cost savings to the state if implemented. For each county and federally recognized tribal government, the department will include in the request for proposal (RFP) the rate at which local funds will be matched. The match rate is based on the most recent Montana State Hospital admission data and census data, as provided in 53-21-1203, MCA.
The department will match county and other local entity funds or in-kind contributions using a sliding scale for state grants as provided in 53-21-1203, MCA. The department will bi-annually recalculate the match rate.
(a) The sliding scale is determined by calculating historical county use of the state hospital using the previous year's admission data versus total state use of the state hospital and county population versus total state population .
(b) The department may grant up to 70% of the local investment to counties below the statewide average admission rate.
(c) The department may match the local investment of cash and in-kind contributions to any county whose MSH admissions are at or above the statewide average admission rate on a sliding scale of 50% to 70% in equal 5% increments. The department's match will not be less than 50% of the local investment.
The county population will be the figure published in Table 1: Annual Estimates of the Population for Counties of Montana: April 1, 2000 to July 1, 2007 (CO-EST2007-01-30). Source: Population Division, U.S. Census Bureau that is adopted and incorporated by reference. Copies of the table may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, P.O. Box 202905, Helena, MT 59620. Eligible participants may use cash or in-kind contributions as matching funds.
The department will recalculate the sliding scale match rate annually using the formula described in 53-21-1203, MCA, based on the prior year's admissions to MSH. If appropriation remains after grants have been allocated, the department will allocate remaining funds to a county or federally recognized tribal government that requests continued funding of a project funded in the previous biennium. In allocating these funds, the department will use the match rate published in the RFP.
AUTH: 53-21-1203, MCA
IMP: 53-21-1203, MCA
GRANTS TO COUNTIES CRISIS DIVERSION GRANTS, PRO RATA DISTRIBUTION (1) If the amount requested for matching fund grants Crisis Diversion Grants exceeds the funding available in the legislative appropriation, the department shall allocate available funding based on a percentage of the total points awarded to an applicant on the pro rata basis described in (2).
The department will allocate funding by dividing available funding by the sum total population of all counties submitting a letter of intent and multiplying the result by the individual county population, subject to the matching fund requirements in ARM 37.89.1005. No county will receive a grant amount larger than the grant amount requested. Points will be awarded by an evaluation committee, as described by the criteria listed within the request for proposal.
(3) If the amount requested for Crisis Diversion Grants exceeds the funding available, the department may use discretion to fund only specific activities within a proposal.
AUTH: 53-21-1203, MCA
IMP: 53-21-1203, MCA
GRANTS TO COUNTIES CRISIS DIVERSION GRANTS, STRATEGIC PLAN REQUIREMENTS (1) Letters of intent (LOI) to participate in the state fund matching grants will be accepted until two weeks after publication of the final adopted version of this rule and grant applications will be accepted until March 1, 2010 for fiscal year 2010 with the grant term concluding at the end of the fiscal year.
(2) For subsequent fiscal years, grant applications that continue or expand activities implemented with a previous year's funding may be given priority over new applications, if the applying county or group of counties have met the requirements of (5) and the department has determined that continuation of the plan would promote appropriate utilizations of the Montana State Hospital and would ultimately result in cost savings to the state.
(3) New and continued grants are subject to the matching requirements in ARM 37.89.1005.
(4)(1) Successful grant applicants will be those submitting a grant application with at least the following elements:
county or multi-county jail diversion and crisis intervention strategic plan, including which must include a plan for community-based or regional emergency crisis response, or court-ordered detention and examination services, as well as and short term inpatient treatment;
(b) a detailed proposal for how the
county or counties grant applicant and other local entities will collaborate and commit local funds for mental health services for crisis intervention, jail diversion, involuntary precommitment, and short-term inpatient treatment costs including a plan for the collection and reporting of data and information;
(c) a detailed budget that identifies cash and in-kind local contribution amounts designated for match, anticipated expenses for each fiscal year being applied for
through June 30 of the funding fiscal year and including start up or one time only costs. Multi-county Multi-jurisdiction grant applications must identify the county or federally recognized tribal government that will act as the fiduciary agent for distribution of the grant funds;
(d) and (e) remain the same.
(5)(2) Each county or group of counties successful grant applicant will submit an annual report to the department within 30 days of the end of each funding year describing implementation of the strategic plan provided for in this rule, including key data elements as defined by the department, for the funded grant period.
AUTH: 53-21-1203, MCA
IMP: 53-21-1203, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Treatment Bureau of the Behavioral Health and Developmental Disabilities Division proposes to amend ARM 37.89.1001, 37.89.1003, 37.89.1005, 37.89.1007, and 37.89.1009 to improve Montana's Behavioral Health Crisis System and to facilitate the distribution of grant funding to urban, rural, frontier, and tribal communities, as provided in 53-21-1203, MCA.
Crisis Diversion Grants are awarded to eligible counties and federally recognized tribal governments to support community-based jail diversion, crisis intervention, and short-term inpatient treatment services for individuals with mental illness. The program is an integral source of funding in local communities for behavioral health crisis intervention and jail diversion services. The reasonable necessity for the proposed amendments is as follows:
To align the program with Montana's Behavioral Health Crisis System Strategic Plan by developing sustainable, evidence based programs to support foundational crisis system infrastructure as recommended by Crisis Now and the Substance Abuse and Mental Health Services Administration (SAMHSA) national guidelines for Behavioral Health Crisis Care; and
To provide for Crisis Diversion Grants to be awarded through a formal process in which counties and federally recognized tribal governments can seek funding in response to a request for proposal (RFP).
Previously, the local communities submitted a letter of intent about the need for matching funds for crisis diversion. The RFP will be issued biennially, after each legislative session, and will formalize the process and include the match rate for each county and tribal government based on the entity's admission rate to Montana State Hospital and census data, as provided in 53-21-1203, MCA.
Crisis Diversion Grants are the primary source of funding to communities for behavioral health crisis intervention and jail diversion services. The proposed amendments will enable Montana's Behavioral Health Crisis System to evolve and develop as local communities establish programs and infrastructure in response to local behavioral health needs.
There is no fiscal impact pertaining to the amendment of the above-referenced rules.
5. The proposed rule changes are intended to be effective upon the day after the date of publication of the adoption notice.
6. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Kassie Thompson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail firstname.lastname@example.org, and must be received no later than 5:00 p.m., September 2, 2022.
7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
8. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 6 above or may be made by completing a request form at any rules hearing held by the department.
9. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
10. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.
/s/ BRENDA K. ELIAS /s/ CHARLES T. BRERETON
Brenda K. Elias Charles T. Brereton, Director
Rule Reviewer Department of Public Health and Human Services
Certified to the Secretary of State July 26, 2022.