Montana Administrative Register Notice 37-598 No. 17   09/06/2012    
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In the matter of the adoption of New Rules I through IV pertaining to alternatives to out-of-state placement for at-risk youths







TO:  All Concerned Persons


            1.  On September 26, 2012, at 10:00 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 adoption 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 September 19, 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 adopted provide as follows:


NEW RULE I  ALTERNATIVES TO OUT-OF-STATE PLACEMENT, PURPOSE  (1)  The purpose of [New Rules I through IV] is to specify provider participation and program requirements to define the basis and procedure available for placement of high-risk children to in-state services as an alternative to out-of-state placement.


AUTH:  52-2-308, MCA

IMP:     52-2-310, 52-2-311, MCA


            NEW RULE II  ALTERNATIVES TO OUT-OF-STATE PLACEMENT, DEFINITIONS  As used in this chapter, the following definitions apply:

            (1)  ″At risk″ means high-needs youth who have proven challenging for typical in-state placements, and are at risk for out-of-state placement or returning from out-of-state placement.

            (2)  ″Qualified provider pool″ means all in-state Medicaid providers who meet the requirements established in [New Rule III] and who are granted access to the department-approved data management system.


AUTH:  52-2-308, MCA

IMP:     52-2-310, 52-2-311, MCA


            NEW RULE III  ALTERNATIVES TO OUT-OF-STATE PLACEMENT, PROVIDER REQUIREMENTS  (1)  Services funded through the program may only be provided by or through a provider that:

            (a)  is enrolled with the department as a Montana Medicaid provider;

            (b)  meets all the requirements necessary for the receipt of Medicaid monies;

            (c)  has been determined by the department to be qualified to provide services to youth with serious emotional disturbance in accordance with the criteria set forth in these rules and must be:

            (i)  a licensed mental health center;

            (ii)  a therapeutic group home;

            (iii)  a psychiatric residential treatment facility; or

            (iv)  a 1915(i) home and community-based state plan provider.

            (d)  is a legal entity; and

            (e)  meets all facility and other licensing requirements applicable to the services covered, the service settings provided, and the professionals employed.


AUTH:  52-2-308, MCA

IMP:     52-2-310, MCA


            NEW RULE IV  ALTERNATIVES TO OUT-OT-STATE PLACEMENT, PROVIDER PARTICIPATION AND PROCEDURES  (1)  Qualified providers and acute care hospitals may request access to the system for an alternative to out-of-state placement by supplying an OM300 form which can be obtained by contacting the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT  59604-4210.

            (2)  Department-approved acute care hospitals and the department may place treatment plans on the department-approved data management system for review by qualified providers.

            (3)  Upon approval for access and according to the requirements of this subchapter a qualified provider may review the treatment plans on the department-approved data management system.  The qualified provider must follow all applicable department rules, policies, and procedures when proposing a plan of care for providing services in-state for at-risk youth.

            (4)  All services that require prior authorization must be prior authorized in accordance with ARM 37.87.903.


AUTH:  52-2-308, MCA

IMP:     52-2-310, 52-2-311, MCA




The Department of Public Health and Human Services (the department) is proposing New Rules I through IV to reflect the statutory amendments made by the 2011 Legislature with House Bill 565 (HB 565) to 52-2-208, 52-2-310, and 52-2-311, MCA.  HB 565 established rulemaking authority for the department to provide children with mental health needs with in-state service alternatives to out-of-state placement.  New Rules I through IV are necessary to implement the department-approved data management system and protocol.  They are also necessary to increase natural supports for youth receiving treatment in-state close to home which is more effective for families and can decrease long-term costs for the state.  Transitioning a youth from out-of-state treatment to in-state community-based services has also proven more difficult due to distance and the lack of common diagnostic requirements and assessments.


The proposed rules are described below.


New Rule I


The proposed language in New Rule I sets forth the purpose of this subchapter.  It provides a clear and concise preamble for this set of rules.


New Rule II


The proposed language in New Rule II defines the terminology that applies to alternatives to out-of-state placement.


New Rule III


The department is proposing New Rule III to specify provider requirements to gain access to the department-approved data management system and to subsequently be a part of the qualified provider pool to provide the services required to at-risk youth.  Due to the nature of the intensive needs of at-risk youth and confidentiality requirements, the department is proposing to limit access to the system to only those providers equipped to serve this population.


New Rule IV


The department is proposing New Rule IV to establish protocol for providers who wish to gain access to the department-approved data management system and review treatment plans for at-risk youth.  The intent of this data management system is to increase effective communication by providing a venue qualified providers may access in order to review the treatment plans and to encourage treatment of at-risk youth in-state and does not alter any applicable department rules, policies, or procedures.  This will make it easier for the department to collect and report information as required by 53-2-311, MCA.


            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., October 4, 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, apply and have been fulfilled.  The primary bill sponsor was contacted by mail on May 25, 2012.




/s/ John C. Koch                                          /s/ Anna Whiting Sorrell                            

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                      Public Health and Human Services


Certified to the Secretary of State August 27, 2012.



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