BEFORE THE Department of Public
health and human services of the
STATE OF MONTANA
TO: All Concerned Persons
1. On April 25, 2013, the Department of Public Health and Human Services published MAR Notice No. 37-634 pertaining to the public hearing on the proposed amendment and repeal of the above-stated rules at page 608 of the 2013 Montana Administrative Register, Issue Number 8. On May 23, 2013, the Department of Public Health and Human Services published an Amended Notice of Public Hearing on Proposed Amendment at page 818 of the 2013 Montana Administrative Register, Issue Number 10.
2. The department has amended and repealed the above-stated rules as proposed.
3. 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: Several commenters requested the department apply the full 4% provider rate increase appropriated by the 63rd Montana Legislature.
RESPONSE #1: While the department thinks that it is worthwhile to pursue incorporation of outcome measures in the distribution of the provider rate increase, there is not enough time to adequately develop meaningful outcome measures this year. As such, the department agrees to distribute the 4% provider rate increase to developmental disabilities providers effective July 1, 2013.
COMMENT #2: One commenter asked how the department expects providers to cover costs of master's level behavioral professionals and medical doctors via the rate proposed for the behavior support service.
RESPONSE #2: While the department sees the potential need to adjust this rate, rate setting outside of the 4% provider rate increase is outside the scope of this rulemaking process. However, the department agrees to consider this comment for future rulemaking.
COMMENT #3: One commenter asked what incentive exists in the proposed waiver to effectively provide behavioral therapy with credentialed and licensed professionals, with Board Certified Behavior Analysts (BCBA), or psychiatrists. They also would like to know how the department proposes to recognize effective behavior intervention strategies and incentivize providers to service intensive individuals in community settings.
RESPONSE #3: This comment is outside of this rulemaking process.
COMMENT #4: One commenter asked what the department's strategy is to allow providers to effectively serve people with intensive needs in community settings via the rates proposed in this MAR notice and alleviate the pressure on Montana Developmental Center.
RESPONSE #4: The purpose of this proposed notice and subsequent amendment is to provide for the 4% provider rate increase. Therefore, this comment is outside the scope of this rulemaking.
COMMENT #5: One commenter raised the question given that aversive treatment, if misapplied could be abusive or assaultive, has the Developmental Disabilities Program created a "race to the bottom" in allowing providers with questionable training to sign off on positive behavior support plans.
RESPONSE #5: This comment is outside of this rulemaking process. The credentials required in order to approve a positive behavior support plan were proposed and adopted into rule in MAR Notice No. 37-599.
COMMENT #6: One commenter asked why psychiatric physicians were not listed as persons who may approve a positive behavior support plan.
RESPONSE #6: This comment is outside of this rulemaking process. The credentials required in order to approve a positive behavior support plan were proposed and adopted into rule in MAR Notice No. 37-599.
COMMENT #7: One commenter asked if the department is creating reverse incentives and rewarding providers to employ staff with the lowest possible training and credentials by allowing bachelor level employees that have an Institute for Applied Behavioral Analysis (IABA) certificate to do the equivalent work of a BCBA.
RESPONSE #7: This comment is outside the scope of this rulemaking.
The final rates may be found in Section Two: Rates of Reimbursement for the HCBS 1915(c) 0208, 1037, 0667 Waiver Programs, of the Developmental Disabilities Program Manual of Service Reimbursement Rates and Procedures, published effective July 1, 2013. A copy of Section Two of the manual may be obtained through the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 and at http://www.dphhs.mt.gov/dsd/ddp/ddprateinformation.shtml.
4. The department intends to apply these rules retroactively to July 1, 2013. A retroactive application of the proposed rules does not result in a negative impact to any affected party.
/s/ Cary B. Lund /s/ Mary E. Dalton acting for
Cary B. Lund Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State July 1, 2013