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Montana Administrative Register Notice 37-571 No. 2   01/26/2012    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.87.1303, 37.87.1307, 37.87.1321, and 37.87.1333 pertaining to home and community-based services (waiver) for youth with serious emotional disturbance

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

            1.  On February 15, 2012, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rules.

 

2.  The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice.  If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on February 8, 2012, to advise us of the nature of the accommodation that you need.  Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

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

 

            37.87.1303  HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE:  FEDERAL AUTHORIZATION AND AUTHORITY OF STATE TO ADMINISTER PROGRAM  (1) through (4) remain the same.

            (5)  In the service areas specified in (4) of this rule, no more than a total of 100 youth per waiver year for all core sites may be enrolled at any given time.  A waiver year begins on October 1st and ends on September 30th.

            (a)  When a waiting list is established in any of the core sites, the protocol defined in the Psychiatric Residential Treatment Facility Home and Community Based Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 2011 will be used by the department to reallocate unused service opportunities.

            (6) remains the same.

 

AUTH:  53-2-201, 53-6-113, 53-6-402, MCA

IMP:     53-6-402, MCA

 

            37.87.1307  HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE:  LOSS OF A SERVICE AND DISENROLLMENT  (1)  A service available through the program may be denied to a youth for the following reasons:

            (a) through (c) remain the same.

            (d)  the financial costs and other impacts on the program due to the delivery of the service to the youth do not conform with the plan of care requirements in accordance with the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 2011.

            (2) remains the same.

 

AUTH:  53-2-201, 53-6-113, 53-6-402, MCA

IMP:     53-6-402, MCA

 

            37.87.1321  HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE:  THE PROVISION OF SERVICES 

            (1) and (2) remain the same.

            (3)  The following services, defined and incorporated by reference in the Psychiatric Residential Treatment Facility Home and Community Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 2011, adopted and incorporated by reference in ARM 37.87.1333, may be provided through the program:

            (a) through (5) remain the same.

 

AUTH:  53-2-201, 53-6-113, 53-6-402, MCA

IMP:     53-6-402, MCA

 

            37.87.1333  HOME AND COMMUNITY-BASED SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE:  REIMBURSEMENT  (1) remains the same.

            (2)  Program services are reimbursed at the lower of the following:

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

            (b)  the fees stated in Appendix A with an effective date of August October 1, 2011 and December 1, 2011 contained in the program's Psychiatric Residential Treatment Facility Home and Community-Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2010 2011.  The department adopts and incorporates by reference the provider policy manual which may be obtained through the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 North Sanders, P.O. Box 4210, Helena, MT 59604-4210.

            (3) through (5) remain the same.

 

AUTH:  53-2-201, 53-6-113, 53-6-402, MCA

IMP:     53-6-402, MCA

 

            4.  STATEMENT OF REASONABLE NECESSITY

 

Amendments Approved by the Centers for Medicare and Medicaid Services

 

The department proposes to update the following rules by incorporating by reference the most current version of the Psychiatric Residential Treatment Facility Home and Community-Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2011:  ARM 37.87.1303, 37.87.1307, 37.87.1321, and 37.87.1333.

 

The department recently received approval from the Centers for Medicare and Medicaid Services (CMS) to amend the 1915(c) Home and Community-Based Services PRTF Waiver for Youth with Serious Emotional Disturbance (SED).  This amendment included two changes:

 

a.  Change the provider qualification for a Family Support Specialist (FSS) to include that the FSS must either have a bachelor's degree in human services or have a minimum of three years direct experience (as documented by the agency) working with youth with SED.  The agency that provides FSS services must ensure that the FSSs receive clinical supervision; and

 

b.  change the unit of service for Education and Support Services from "per series (package)" to "per session."

 

The changes listed above do not have a negative impact on the youth and families served under the PRTF Waiver or the providers of FSS services.

 

The proposed amendments are necessary for an accurate reflection of the most up-to-date policy manual which contains the amendments to the waiver as approved by CMS [provider qualification change for a Family Support Specialist (FSS) and the unit of service change for Education and Support Services].  By having the information in the manual, providers will be more familiar with these changes.  The proposed amendments allow agencies the opportunity to provide FSS services by staff that either have a bachelor's degree in human services or have a minimum of three years direct experience (as documented by the agency) working with youth with SED (the agency that provides FSS services must ensure that the FSSs receive clinical supervision).  This will be helpful in areas where the Waiver is operational and there are staff shortages due to the previous requirement that a bachelor's degree in human services was necessary.  In addition, proposing to change the unit of service for Education and Support Services from "per series (package)" to "per session" will increase the provider's capacity to provide the service.  Previously, providers were reluctant to deliver the service due to the limitation of providing a per series package at a low rate of reimbursement.

 

The department chose this approach to avoid any confusion for providers of waiver services.  Without describing the two changes approved by CMS, providers would not be familiar with the proposed amendments to Family Support Specialist services and/or Education and Support Services.  Youth enrolled in the Waiver program may have gone without the services as the providers would not have been informed, without the most current version of the provider manual.

 

The department is taking this opportunity to rephrase cumbersome language in ARM 37.87.1321(3) referring to adoption of the Psychiatric Residential Treatment Facility Home and Community-Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual.  No substantive change, other than the policy manual update, is intended.

 

Fiscal Impact

 

There is no anticipated fiscal impact from these rules.  The change in the unit definition is not anticipated to substantially increase or decrease waiver expenditures; it is anticipated to increase access to the services and remain within the federally approved waiver projections.  Use of any particular waiver service is governed by the need of the individual youth being served.

 

Persons and Providers Affected

 

At capacity, 100 youth may be enrolled in the waiver at any given time; the cost of the waiver must be less than or equal to the cost of serving the youth in a PRTF facility.  The number of persons affected:  100 youth at any given time in the counties where waiver enrollment is available.  There are approximately 61 enrolled waiver providers in Montana who would be affected.

 

Proposed Amendment to the Centers for Medicare and Medicaid Services

 

The department proposes to update ARM 37.87.1333 by incorporating by reference the most current version of the Psychiatric Residential Treatment Facility Home and Community-Based Services Waiver for Youth with Serious Emotional Disturbance Provider Policy Manual dated October 2011; Appendix A, Service Codes and Reimbursement- Effective December 1, 2011.

 

The department will be submitting to the CMS an amendment to the 1915(c) Home and Community-Based Services PRTF Waiver for Youth with Serious Emotional Disturbance.  This amendment includes two changes, reflected in the policy manual:

 

a.  An increase in the rate of reimbursement for the Caregiver Peer-to-Peer Specialist to $10.50 per unit of service; a unit of service is defined as 15 minutes.  Additionally, the Caregiver Peer-to-Peer Specialist will bill the 15-minute unit when attending meetings.  This change will incentivize providers to participate in the program.

 

b.  A change to language in the waiver document allowing for the plan manager position to be contracted.  The current language states the plan manager is an employee of the Department of Public Health and Human Services.

 

The changes listed above do not have a negative impact on the youth and families served under the PRTF Waiver or the providers of services.

 

The proposed amendments are necessary to accurately reflect the most up-to-date policy manual which contains the amendments and pending amendments to the Waiver.  By having the information in the manual, providers will be familiar with these changes.  The proposed amendment will allow agencies the opportunity to provide Caregiver Peer-to-Peer Specialist services; the previous rate was too low for agencies to hire staff.  The policy manual further clarifies that the Plan Manager position may be contracted through an entity within the community.  The department is proposing to update the current version of the provider manual to avoid any confusion for providers of waiver services pertaining to such policy.  Providers would not be familiar with the details of the increased rate for the Caregiver Peer-to-Peer Specialist service without a rule change and fee schedule update.  The increase in the rate was proposed by providers as the previous rate was too low to hire Caregiver Peer-to-Peer Specialists.  Youth enrolled in the Waiver program may have gone without the services as the providers would not have been informed, without the most current version of the provider manual.

 

Potential Fiscal Impact

 

Anticipated fiscal impact from the increase in the unit rate (and discontinuation of the meeting rate) is approximately $306,950 per year.

 

Persons and Providers Potentially Affected

 

At capacity, 100 youth may be enrolled in the waiver at any given time; the cost of the waiver must be less than or equal to the cost of serving the youth in a PRTF facility.  The number of persons affected:  100 youth at any given time in the waiver in the counties where waiver enrollment is available.  There are approximately 61 enrolled waiver providers in Montana who could also be affected.

 

            5.  Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing.  Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., February 23, 2012.

 

6.  The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

7.  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 5 above or may be made by completing a request form at any rules hearing held by the department.

 

8.  An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.

 

9.  The bill sponsor contact requirements of 2-4-302, MCA do not apply.

 

 

 

/s/ John Koch                                               /s/ Mary E. Dalton acting for                      

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

           

Certified to the Secretary of State January 17, 2012.

 

 

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