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| Montana Administrative Register Notice 37-614 | No. 21 11/08/2012 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On November 28, 2012, at 1:30 p.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium 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 November 21, 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:
37.87.102 Mental Health SERVICES (MHS) for YOUTH with serious emotional disturbance (SED), Definitions As used in this chapter, the following terms apply: (1) "Accredited secondary school" means a secondary school accredited in accordance with Montana Board of Public Education standards for secondary education. (1) through (14) remain the same, but are renumbered (2) through (15). (a) for Medicaid services, a person 17 years of age and younger or a person who is up to 20 years of age and is enrolled in an accredited secondary school with the exception for PRTF services, a person 17 years of age or younger; or (b) remains the same.
AUTH: 53-2-201, 53-6-113, 53-21-703, MCA IMP: 53-1-601, 53-1-602, 53-1-603, 53-2-201, 53-21-201, 53-21-202, 53-21-701, 53-21-702, MCA
37.87.1216 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY SERVICES, BENEFIT LIMITS, CERTIFICATION OF NEED (3) Medicaid reimbursement for PRTF services is not available for youth 18 years of age and older. (3) and (4) remain the same, but are renumbered (4) and (5).
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.1217 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, TREATMENT REQUIREMENTS (1) and (2) remain the same. (3) A PRTF must submit a request for an eligibility determination to the department's developmental disability program (DDP) for youth suspected of having a developmental disability if a request has not already been made for youth 8 to 18 years of age. An eligibility determination for adult services may be requested for youth 16 years or older. (a) the PRTF must complete and submit to the DDP a cover letter along with the psychological testing and assessments required by the DDP; and (b) the PRTF must complete and submit additional documentation, if requested by the DDP. (4) The PRTF must use a functional assessment approved by the department's children's mental health bureau for youth on admission and prior to discharge to assist in the development of the plan of care and the discharge plan. (3) through (8) remain the same, but are renumbered (5) through (10).
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.1222 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, INTERIM RATE AND COST SETTLEMENT PROCESS (1) through (11) remain the same. (12) Care coordination services will be reimbursed to the PRTF at the prevailing Medicaid rate for Healthcare Common Procedure Coding System (HCPCS) code T1016 (a) through (d) remain the same. (13) Reimbursement will be made to (a) and (b) remain the same. (c) the provider clearly documents staff contact and youth achievements or regressions during and following the therapeutic home visit; (d) the youth is absent from the provider's facility for no more than three patient days per therapeutic home visit, unless additional days are authorized by the department (e) the out-of-state PRTF pays for transportation for youth on a therapeutic home visit from an out-of-state PRTF. (14) through (16) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.1223 PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) SERVICES, REIMBURSEMENT (1) and (2) remain the same. (3) The statewide bundled per diem interim rate for in-state PRTF services is the lesser of: (a) the amount specified in the department's (b) and (4) remain the same.
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) is proposing amendments defining a number of Psychiatric Residential Treatment Facility (PRTF) rules regarding the age youths can be served in a PRTF for purposes of Medicaid reimbursement and specifying that a secondary school in the definition of "youth" be accredited. The department is proposing amendments requiring PRTFs to use the functional assessment approved by the department's Children's Mental Health Bureau (CMHB), requiring PRTFs to refer youth suspected of having a developmental disability to the department's developmental disability program, allowing adult targeted case managers to be reimbursed for care coordination for transition age youth, and allowing therapeutic home visits for youth in out-of-state PRTFs. These proposed amendments are necessary for efficient management by the department and providers.
ARM 37.87.102 and ARM 37.87.1216
The department is proposing to amend ARM 37.87.102 and 37.87.1216, specifying the existing CMHB policy that PRTF services are only available to youth below the age of 18. Other mental health services are available for youth to age 20, if they are ″enrolled in a secondary school." The "enrolled in a secondary school" language creates confusion for providers, parents/legal guardians, and other stakeholders as to what services are available to youth and when youth should be transitioned to adulthood or adult mental health services. We are also proposing to add the requirement that secondary schools be accredited in accordance with the Montana Board of Public Education (BPE) standards for secondary education. The department is proposing to add a definition for "accredited secondary school" that specifies the BPE standards are used for accreditation of secondary schools. These changes are not expected to have any fiscal impact upon providers or youths. These amendments are necessary to improve communication between the department, providers, and parents/legal guardians.
ARM 37.87.1217
The department is proposing language to require PRTFs to use the same department-approved functional assessment in treatment and discharge planning, beginning July 1, 2013. This is necessary in order to communicate consistently and in a common language regarding the youth's functional needs. CMHB believes requiring the use of the same functional assessment will assist those involved in the youth's treatment and discharge planning. The intensity of active treatment and the adequacy of discharge planning currently vary by PRTF. The consistent functional assessment should also assist to better identify whether the youth is making progress and whether the treatment program is appropriate for the youth's needs.
Most of the enrolled PRTFs currently use a functional assessment. The department is not proposing to reimburse the PRTFs for completing this assessment. There may be a fiscal impact to the provider for completing this functional assessment if they are not currently using the one approved by the department.
The department is also proposing language that would require PRTFs to submit eligibility determination requests to the department's developmental disabilities program (DDP) for youth in their facility, ages 8 to 18, if they believe the youth has a developmental disability (DD). This is necessary to identify the number of youth with a developmental disability and will assist the department in planning for needed DD services. If the child is determined eligible for DD services a referral would then be required. If DD services are not available when a referral is made the youth may be placed on a waiting list. DD services may be the most appropriate services for the youth and determining whether a youth has a developmental disability will also assist the PRTF in individualizing the youth's treatment in their facility.
The department is not proposing to reimburse the PRTFs for completing the psychological testing and functional assessment used to determine DDP eligibility. Psychological testing is included in the per diem bundled psychiatric rate. There may be a small fiscal impact to the provider for completing the DDP functional assessment. There is not expected to have a fiscal impact for the department.
ARM 37.87.1222
The department is proposing to take modifier "HA" off the targeted case manager (TCM) code in ARM 37.87.1222. This is necessary so care coordination services provided by an adult TCM for youth transitioning to adult mental health services are reimbursed at the adult TCM rate.
The department is also proposing to allow 14 therapeutic home visit (THV) days for youth in out-of-state PRTFs. This is necessary to be consistent with the number of THVs allowed for youth in in-state PRTFs. Fourteen days would be limited per state fiscal year (SFY). It is difficult to discharge youth from an out-of-state PRTF and THVs would help the youth and family to practice the clinical gains they have made in treatment, before discharge.
Adding THVs to out-of-state PRTFs is not expected to have a significant fiscal impact. Most youth are served by in-state PRTFs and the number of THVs to out-of-state PRTFs has been minimal. We are also proposing the out-of-state PRTF reimburse the travel expenses to and from Montana for out-of-state THVs.
ARM 37.87.1223
The department is proposing to amend ARM 37.87.1223 to update the title of the Medicaid Mental Health and Mental Health Services Fee Schedule, Individuals Under 18 Years of Age. This is necessary because effective July 1, 2012, the title for the above-mentioned fee schedule was changed to Medicaid Youth Mental Health Services Fee Schedule. This fee schedule is adopted and incorporated in ARM 37.87.901.
Fiscal Impact
While there is no fiscal impact to the department, there may be a small fiscal impact to providers. The department does not have enough data to calculate that fiscal impact at this time.
Number of Youth and PRTFs Affected
The unique caseload count for PRTF services so far for SFY 2013 is 166. The unique caseload count for SFY 2012 was 463. There are 3 in-state and 11 out-of-state PRTFs enrolled in the Montana Medicaid Program.
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., December 6, 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/ Anna Whiting Sorrell Rule Reviewer Anna Whiting Sorrell, Director Public Health and Human Services
Certified to the Secretary of State October 29, 2012
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A directory of state agencies is available online at http://www.mt.gov/govt/agencylisting.asp.
For questions about the organization of the ARM or this web site, contact sosarm@mt.gov.
