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Montana Administrative Register Notice 37-652 No. 20   10/31/2013    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the adoption of New Rules I through III and the amendment of ARM 37.34.901, 37.34.902, 37.34.906, 37.34.907, 37.34.911, 37.34.912, 37.34.913, 37.34.917, 37.34.918, 37.34.919, 37.34.925, 37.34.926, 37.34.929, 37.34.930, 37.34.933, 37.34.934, 37.34.937, 37.34.938, 37.34.941, 37.34.942, 37.34.946, 37.34.947, 37.34.950, 37.34.951, 37.34.954, 37.34.955, 37.34.956, 37.34.957, 37.34.960, 37.34.961, 37.34.962, 37.34.963, 37.34.967, 37.34.968, 37.34.971, 37.34.972, 37.34.973, 37.34.974, 37.34.978, 37.34.979, 37.34.980, 37.34.981, 37.34.985, 37.34.986, 37.34.987, and 37.34.988 pertaining to Medicaid home and community-based services program

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION AND AMENDMENT

 

 

TO: All Concerned Persons

 

            1. On November 20, 2013, 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 adoption and 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 13, 2013, 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 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM: WAIVER-FUNDED CHILDREN'S CASE MANAGEMENT (1) Waiver-funded children's case management (WCCM) services are services furnished to assist a person in gaining access to needed medical, social, educational, and other services. WCCM includes the following assistance:

            (a) comprehensive initial assessment and periodic reassessment to determine a child's need for any medical, educational, social, or other services;

            (b) development and periodic revision of a specific care plan;

            (c) referral and related activities to help an eligible child to obtain needed services;

            (d) monitoring and follow-up activities including activities and contacts that are necessary to ensure the plan of care is implemented and adequately addresses the child's needs;

            (e) completion of the freedom of choice form; and

            (f) assistance with crisis intervention planning to locate suitable alternative placement when the person's health or safety is at risk.

            (2) WCCM may not provide:

            (a) case management activities that are a component of another covered Medicaid service;

            (b) direct delivery of medical, educational, social, or other services the person has been referred to; or

            (c) administration of foster care programs or other nonmedical programs.

            (3) A person providing WCCM must:

            (a) possess a bachelor's degree in social work or a related field from an accredited college and have one year of experience in human services, or have provided case management services, comparable in scope and responsibility to that provided by targeted case managers, to persons with developmental disabilities for at least five years;

            (b) have at least one year's experience in the field of developmental disabilities or, if lacking such experience, complete at least 40 hours of training in the delivery of services to persons with developmental disabilities under a training plan reviewed by the Developmental Disabilities Program (DDP) within three months of hire or designation as a case manager;

            (c) participate in a minimum of 20 hours of training in services to persons with developmental disabilities each year, including abuse prevention training provided by the DDP under a training plan reviewed by the DDP; and

            (d) case managers who have not been certified must participate in the first MONA (the Montana resource allocation protocol tool) or mini MONA certification training opportunity available after hire.

            (4) A staff person providing case management to youth age 16 through 21 must be certified to complete the personal support plan.

            (5) Documentation of the qualifications of a case manager and completion of mandated training must be maintained by the employer.

 

AUTH: 53-6-113, 53-6-402, MCA

IMP:     53-6-101, 53-6-402, MCA

 

            NEW RULE II 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: SELF-DIRECTED SERVICES, DEFINITIONS  (1) "Agency with choice model" means an agency that is the legal entity that is the fiscal agent to assist the person conducting the business of self-direction. The legal entity is the legal employer and is responsible for all aspects of hiring and managing staff and service documentation requirements.

            (2) "Financial management service (FMS)" means the fiscal agent who assists the person conducting the business of self-direction. The fiscal agent educates the person, self-directing and acting as an employer, as to their responsibilities, processes employment paperwork, administers necessary preemployment screening, and processes employee timesheets. The fiscal agent must withhold and pay all employment related taxes and arranges for worker's compensation for all employees.

            (3) "Person with employer authority using a fiscal management service" means the person or legal representative who is the legal employer and who is responsible for all aspects of hiring and managing staff and service documentation requirements.

 

AUTH: 53-6-113, 53-6-402, MCA

IMP:     53-6-101, 53-6-402, MCA

 

            NEW RULE III 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: SELF-DIRECTED SERVICES, REQUIREMENTS (1) A person living in a natural home or private residence may elect to self-direct some or all of their waiver services using:

            (a) an agency with choice model; or

            (b) an employer authority using a financial management services (FMS) option.

            (2) In order to elect the self-directed with employer authority using an FMS option, the person must:

            (a) receive Developmental Disabilities Program (DDP) Medicaid-funded waiver services; and

            (b)  live in their natural home or private residence in which the person's choice of services, support worker, and schedule for delivery of service has no adverse effect on other persons receiving waiver services.

            (3) A person may opt out of self-directed services at any time and receive traditional agency-based services model.

            (4) A person who chooses to disenroll from the self-directed service model must contact the case manager to schedule a planning meeting to determine the services he or she requires in the traditional agency-based services model.

 

AUTH: 53-6-113, 53-6-402, MCA

IMP:     53-6-101, 53-6-402, MCA

 

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

 

            37.34.901 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  AUTHORITY (1) The department has been granted by the United States dDepartment of hHealth and hHuman sServices (HHS) the authority, through 42 USC 1396n(c) and 42 CFR 441.300 through 441.310, to provide Medicaid home and community-based services (HCBS) to persons with developmental disabilities. The authority to implement this program is provided in 42 USC 1396n(c) and 42 CFR 441.300 through 441.310. These rules implement in Montana the 0208 Medicaid hHome and cCommunity sServices Waiver pProgram for persons with developmental disabilities.

            (2) In accordance with the state and federal statutes and rules generally governing the provision of Medicaid-funded home and community-based services and the federal-state agreement specifically governing the provision of the Medicaid-funded home and community waiver services to be delivered through this program, and within the fiscal limitations of the funding appropriated and available for the program, the department may determine within its discretion the following features of the program:

            (a) the types of services to be available;

            (b) the amount, scope, and duration of the services;

            (c) the target population;

            (d) individual eligibility; and

            (e) delivery approach. 

 

AUTH:   53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.902 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  GENERALLY (1) The Medicaid home and community services program for persons who are developmentally disabled serves persons:

            (a) who would otherwise require the level of care provided in an intermediate care facility for the mentally retarded (ICF/MR); and

            (b) for whom services provided through the Medicaid home and community services program will not jeopardize the person's health and safety.

            (2) Eligibility of applicants for the Medicaid home and community services program is determined as provided in ARM 37.34.906. 

            (3) Placement into Medicaid home and community services is determined as provided in ARM 37.34.301, et seq.

            (4) (1) Services and placements in selection into services through the 0208 Medicaid hHome and cCommunity sServices Waiver pProgram are available only to the extent that the federal approval of the state's program permits and that available funding allows.

            (5) (2) The department, in order to comply with federal requirements or to limit expenditures to available funding, may:

            (a) reduce the number of Medicaid recipients persons that may be served under the program;

            (b) and (c) remain the same.

           

AUTH:    53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:       53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.906 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: ELIGIBILITY (1) Under the Medicaid home and community services program, services may be provided to a person whom the department determines: A determination that a person is eligible to be considered for acceptance into the Medicaid Home and Community-Based Services (HCBS) Waiver Program does not entitle a person to selection and entry into the HCBS Waiver Program.

            (2) A person is eligible to be considered for acceptance into the Medicaid HCBS Waiver Program if the person:

            (a) has a developmental disability, as defined in 53-20-202, MCA is determined by the Developmental Disabilities Program (DDP) to be a person with a developmental disability in accordance with the criteria specified and approved in the waiver from the Centers for Medicare and Medicaid Services and in accordance with Title 37, chapter 34, subchapter 2;

            (b) is eligible for Medicaid applies for and meets the applicable Medicaid financial eligibility requirements found in ARM Title 37, chapter 82; and

            (c) requires the level of care provided in an intermediate care facility for the mentally retarded (ICF/MR) individuals with intellectual disability (ICF/IID), as determined by an evaluation of the person's service needs by: the DDP.

            (i) the intensive services review committee, as provided in ARM 37.34.907; or

            (ii) a qualified mental retardation professional, as defined in ARM 46.12.1310, employed by the department; and

            (d) does not reside in a hospital or long term care facility as defined in 50-5-101, MCA.

            (i) A long term care facility provides skilled or intermediate nursing care, ICF/MR care and personal care.

            (2) (3)  The level of care of an ICF/MR IID is needed when a person who is mentally retarded intellectually disabled:

            (a) through (c) remain the same.

            (d) has specialized services service needs, and exhibits physical or mental limitations or changes similar to those expected in an older person.

            (3) (4)  A person who has been admitted to an ICF/MR IID and who is dismissed discharged to enter services under the 0208 Medicaid home and community services HCBS Waiver pProgram for persons with developmental disabilities is considered to be of the level of care of an ICF/MR IID and need not be evaluated as provided in (1) (2)

            (5)  For a person through the age of seven, the eligibility review panel (ERP) must make the determination of eligibility.

            (6) The ERP must consist of the following members:

            (a) a waiver-funded children's case manager;

            (b) a provider's administrator or supervisor;

            (c) a department's quality improvement specialist;

            (d) a staff person who has had recent contact with the child, if applicable; and

            (e) other members as determined by the panel, if applicable.

            (7) The waiver-funded children's case manager must submit the following to the ERP for a determination of eligibility:

            (a) a diagnostic statement from a physician; and

            (b) any testing that reflects developmental delays; or

            (c) a Vineland II (adaptive functioning assessment);

            (d) a current psychological evaluation; and

            (e) the eligibility determination form for children.

            (8) For eligibility determinations made by the ERP, The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual does not apply to an eligibility determination for a child up to age seven.

            (9) The ERP may determine a child is eligible if:

            (a) the child has a diagnosis of a physical or mental condition that has a high probability of resulting in a developmental disability; or

            (b) the child is experiencing developmental delays, with a 50% delay in one of the following areas or a 25% delay in two or more of the following areas:

            (i) cognitive development;

            (ii) physical developments, including vision and hearing;

            (iii) speech and language development;

            (iv) social and emotional development; or

            (v) self-help skills.

            (10) The department designee must annually administer a level of care re-determination.

            (11) A child who has previously been determined eligible for services by the ERP must have a determination of eligibility by the department's eligibility specialist prior to the child's eighth birthday.

            (12) For a person age eight and older, the department must make a determination of eligibility for consideration of acceptance into the 0208 HCBS Waiver Program.

            (13) The department may make a determination of eligibility for acceptance into the 0208 HCBS Waiver Program as early as the age of six.

            (14) The following documents must be submitted to the department's eligibility specialist to make a determination of eligibility for acceptance into the 0208 HCBS Waiver Program:

            (a) a Vineland II;

            (b) a current psychological evaluation, that for adults, is no more than ten years old; and

            (c) page one of the eligibility determination form.

            (15) The Determining Eligibility for Services to Persons with Developmental Disabilities in Montana: A Staff Reference Manual, as adopted in ARM 37.34.201, sets forth the requirements for eligibility of the DDP's service programs.

            (16) Upon a determination of ineligibility, if the person is:

            (a) on the waiting list, his or her name will be removed from the waiting list; or

            (b) currently in waiver services, he or she will be exited from the 0208 HCBS Waiver Program ten days from the date of the notification letter.

 

AUTH:   53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.907 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  INTENSIVE SERVICES REVIEW COMMITTEE SELECTION AND ENTRY  (1) The intensive services review committee (ISRC) is a state level committee that may review persons referred to the Medicaid home and community services program to determine if the person meets the level of care of an ICF/MR, as provided in ARM 37.34.906 and is therefore eligible for the program. A person may be placed on the statewide waiting list for consideration for selection and entry into the 0208 Medicaid Home and Community-Based (HCBS) Waiver Program if the person is found eligible for the Developmental Disabilities Program (DDP) service in accordance with ARM 37.34.906.

            (2) The ISRC is composed of at least one representative from the developmental disabilities program and a provider of intensive services. A developmental disabilities case manager and a nurse may also be included on the committee. The DDP will enter the person's name onto the waiting list in chronological order based upon the date the case manager receives a complete request for services.

            (3) The selection for consideration of persons with the same waiting list date will be made through a random selection process.

            (4) The DDP designee must notify a person selected for entry into the 0208 HCBS Waiver Program and the person's case manager in writing within ten working days of selection.

            (5) Within five working days from the date of the notification letter the department designee must present all waiver service options available to the person selected and document which providers the person requests to meet and submit to the providers:

            (a) the provider service referral packet;

            (b) the plan of care; and

            (c) other documents, as requested.

            (6) A provider must contact the department designee within ten working days from the date the provider service referral packet was submitted to the provider and either:

            (a) offer to serve the person; or

            (b) decline to offer services.

            (7) The person must determine which provider(s) he or she will accept services from within five days following the offer(s).

            (8) The case manager must: 

            (a) document the person's choice of provider(s);

            (b) obtain the person's or the person's legal representative's signature; and          (c) maintain the documentation in the person's file.

            (9) Upon acceptance of service(s), the person must begin service(s) within 45 working days from the date of the provider(s) offer to serve the person.

            (10) The department may prioritize and select a person who has a life-threatening physical condition, is eligible for DDP services, and that without services would jeopardize their continued existence.

            (11) The department reserves the right to select a person from the waiting list based upon emergency criteria if all other service options have been reviewed and do not meet the person's health and safety needs. The emergency criteria are as follows:

            (a) a finding of maltreatment is determined by Child Protective Services or Adult Protective Services;

            (b) death or inability of the person's primary caregiver to provide care and no alternative caregiver is available; or

            (c) lack of appropriate placement for the person due to loss of housing or imminent discharge from the temporary placement or hospitalization.

            (12) A person who is selected for entry into the 0208 HCBS Waiver Program and does not accept waiver services will be removed from the waiting list.

            (13) If the person selected for entry into the 0208 HCBS Waiver Program cannot find a provider able or willing to provide services within 90 days from the date of the selection notification letter, the opening is forfeited.

            (14) A person discharged from an ICF/IID located in the state of Montana who is eligible for home and community-based services in accordance with ARM 37.34.906 is not subject to the selection criteria and entry procedures otherwise stated in this rule. The department in its discretion may provide the person with a placement in the 0208 HCBS Waiver Program.

 

AUTH:    53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.911 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  AVAILABLE SERVICES (1) The following services may be provided under the Medicaid hHome and cCommunity-based sServices pProgram:

            (a) intensive support coordination services adaptive equipment, as provided in ARM 37.34.925 and 37.34.926;

            (b) homemaker services adult companion, as provided in ARM 37.34.929 and 37.34.930 37.34.926;

            (c) personal care services adult foster, as provided in ARM 37.34.933 and 37.34.934 37.34.929;

            (d) adult day services assisted living, as provided in ARM 37.34.937 and 37.34.938 37.34.930;

            (e)  habilitation services behavioral support, as provided in ARM 37.34.941 and 37.34.942 37.34.933;

            (f) respite care services caregiver training and support, as provided in ARM 37.34.946 and 37.34.947 37.34.934;

            (g) occupational therapy services community transition, as provided in ARM 37.34.950 and 37.34.951 37.34.937;

            (h) physical therapy services day supports and activities, as provided in ARM 37.34.954 and 37.34.955 37.34.938;

            (i) speech therapy services environmental modifications, as provided in ARM 37.34.956 and 37.34.957 37.34.941;

            (j) environmental modifications homemaker, as provided in ARM 37.34.960 and 37.34.961 37.34.942;

            (k) adaptive equipment individual goods and services, as provided in ARM 37.34.962 and 37.34.963 37.34.946;

            (l) transportation services job discovery, as provided in ARM 37.34.967 and 37.34.968 37.34.947;

            (m) psychological and professional counseling services job preparation, as provided in ARM 37.34.971 and 37.34.972 37.34.950;

            (n) nursing services live-in caregiver, as provided in ARM 37.34.973 and 37.34.974 37.34.951;

            (o) dietitian services meals, as provided in ARM 37.34.978 and 37.34.979 37.34.954;

            (p) supported living coordination nutritionist, as provided in ARM 37.34.985 and 37.34.986 37.34.955;

            (q) meal services occupational therapy, as provided in ARM 37.34.980 and 37.34.981 37.34.956; and

            (r) respiratory services personal care, as provided in ARM 37.34.987 and 37.34.988. 37.34.957;

            (s) personal emergency response, as provided in ARM 37.34.960;

            (t) personal supports, as provided in ARM 37.34.961;

            (u) physical therapy, as provided in ARM 37.34.962;

            (v) private duty nursing, as provided in ARM 37.34.963;

            (w) psychological services, as provided in ARM 37.34.967;

            (x) remote monitoring equipment, as provided in ARM 37.34.968;

            (y) remote monitoring equipment, as provided in ARM 37.34.971;

            (z) residential habilitation, as provided in ARM 37.34.972;

            (aa) residential training support, as provided in ARM 37.34.973;

            (ab) respite, as provided in ARM 37.34.974;

            (ac) retirement services, as provided in ARM 37.34.978;

            (ad)  speech therapy, as provided in ARM 37.34.979;

            (ae) supported employment, follow along, as provided in ARM 37.34.980;

            (af) supported employment, individual employment support, as provided in ARM 37.34.981;

            (ag) supported employment, small group, as provided in ARM 37.34.985;

            (ah) supported employment, coworker support, as provided in ARM 37.34.986;

            (ai) supports brokerage, as provided in ARM 37.34.987;

            (aj) transportation, as provided in ARM 37.34.988; and

            (ak) waiver-funded children's case management, as provided in [NEW RULE I].

            (2) Services available provided to a recipient person through the 0208 HCBS Waiver pProgram are limited to the services specified in the recipient's person's individual plan of care and the individual cost plan.

            (3) Services available to a recipient through the program are limited to services that are not available otherwise to the recipient through the state Medicaid program or any other local government, state or federal program for which the person is eligible or would be eligible upon application. Services may be provided when required services exceed or are different from the services available in the Montana state plan.

 

AUTH:   53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.912 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: GENERAL PROVIDER REQUIREMENTS (1) Medicaid home and community services may be provided only by providers under contract with the department. The criteria for a qualified provider to be authorized to deliver a service available through the 0208 HCBS Waiver Program are specified in the Provider Specifications for Services Matrix for the 0208 HCBS Waiver Program.

            (2) A provider that is among the providers listed in ARM 37.34.1801 must be accredited as provided in that rule. The Provider Specifications for Services Matrix for the 0208 HCBS Waiver Program, dated December 27, 2013, sets forth the qualifications and standards that govern provider requirements in the provision of 0208 HCBS waiver services.

            (3) The department adopts and incorporates by reference the Provider Specifications for Services Matrix for the 0208 HCBS Waiver Program, dated December 27, 2013.

            (4) A copy of the matrix may be obtained through the Department of Public Health and Human Services, Developmental Disabilities Program, 111 N. Sanders, PO Box 4210, Helena, MT 59604-4210 or at http://www.dphhs.mt.gov/dsd/ddp/medicaidwaivers.shtml.

            (5) A provider must document the completion of training in the personnel file of the staff including:

            (a) the date of the training;

            (b) name and title of trainer;

            (c ) name and signature of person receiving the training;

            (d) type of training;

            (e) the agenda of the training; and

            (f) hours of training.

            (3) remains the same, but is renumbered (6)

            (4) Reimbursement for services, except for transportation service as defined in ARM 37.34.967, shall not be made to parents of minor children or to spouses unless the department approves reimbursement based on a determination by the department that the spouse or parent is delivering a service, not normally a spousal or parental responsibility, requiring specialized skills that necessitate professional type training and knowledge.

            (5) (7)  Individual persons A person directly providing services must be mentally and physically capable of assisting recipients a person receiving services as required by the program.

 

AUTH:   53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.913 0208 COMPREHENSIVE PROGRAM OF MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  REIMBURSEMENT (1) Reimbursement for the provision of services or items funded through the 0208 Comprehensive Program of Home and Community Services Medicaid Home and Community-Based Services Waiver Program is available in accordance with criteria and procedures in ARM 37.34.3001 and 37.34.3002

            (2) The rates of reimbursement for particular types of services and items that may be funded through the 0208 Comprehensive Program of Home and Community Services Medicaid Home and Community-Based Services Waiver Program are established in accordance with ARM 37.34.3005

 

AUTH:    53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.917 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: INDIVIDUAL PLANS OF CARE TERMINATION OF PLACEMENT

            (1) Individual plans of care for recipients of Medicaid home and community services must: The department may terminate a person's placement in the 0208 Medicaid Home and Community-Based Services Waiver Program if the person does not meet the requirements for the program, in accordance with this subchapter.

            (a) conform with ARM 46.8.105 or alternative procedures approved by the department;

            (b) include a description of each service to be provided, the frequency of those services, and the type of provider; and

            (c) include the projected annualized costs of each service.

            (2) The individual plan of care must be reviewed and approved by the department. The department may terminate a person's placement if:

            (a) the program services or funding necessary to implement the person's service plan are unavailable from the program;

            (b) the professional and other services necessary to implement the person's service plan are unavailable;

            (c) the person does not cooperate in the eligibility determination process;

            (d) the person does not participate in the planning for service delivery;

            (e) the program services are no longer appropriate or cost efficient in relation to the person's needs and there are no alternative program services available by which a service plan can be implemented to provide for the person's needs;

            (f) the person poses imminent risk to the health and safety of the person or another person by not participating in the program services available to that person;

            (g) behaviors of the person precluded the delivery of program services as provided for in the person's service plan;

            (h) behaviors of the person necessitate that the person must be served in a setting that is not available through the program or in which the services of the program may not be delivered; or

            (i) health status of the person necessitates that the person must be served in a setting that is not available through the program or in which the services of the program may not be delivered.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.918 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: INFORMING BENEFICIARY OF CHOICE FREEDOM OF CHOICE 

            (1) A person determined by the department to require the level of care provided in an ICF/MR IID must be given a choice between placement in an ICF/MR IID or in the 0208 Medicaid hHome and cCommunity-Based sServices (HCBS) Waiver pProgram.

            (2) The person or legal representative must be informed of the feasible alternatives in the community, if any, available under the 0208 Medicaid home and community services program HCBS Waiver Program.

            (3) The Quality Improvement Specialist will complete the Waiver 5, Freedom of Choice form with the person during the initial face-to-face level of care determination and document, in the person's file, that the person was given the choice and record the choice the person made.

            (4) Case managers must inform the person currently served in the 0208 HCBS Waiver Program annually of feasible alternatives in the community and provide documentation for the person's file.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.919 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: NOTICE AND FAIR HEARING (1) The department will provide written notice to applicants for and recipients of Medicaid home and community services (HCBS) Waiver Program when determinations are made by the department concerning their status pertaining to level of care and selection or denial for placement.

            (a) The department will provide a recipient with notice ten working days before termination of services due to a determination of ineligibility.

            (2) The department will provide a recipient at least 30 calendar days notice before any termination or reduction of services due to limitations upon services or insufficient program funds, as provided in ARM 37.34.902(4).

            (3) (1)  A person aggrieved by an adverse determination by the department determination for a level of care determination finding the person ineligible for services may request a fair hearing as provided in 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.318, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337 Title 37, chapter 5, subchapter 3.

            (4) A person may request a review and a fair hearing as provided in ARM 37.34.335 for a non-selection or denial of a service made by the department. A person may not appeal a termination or reduction in services undertaken by the department in accordance with ARM 37.34.902(4).

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.925 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: INTENSIVE SUPPORT COORDINATION SERVICES, DEFINITION ADAPTIVE EQUIPMENT  (1) Intensive support coordination services are services for the support and coordination of Medicaid home and community services provided to individual recipients in the intensive family support program. Adaptive equipment is equipment necessary for the person to obtain or retain employment or to increase independent functioning in completing activities of daily living.

            (2) Intensive support coordination services include: Adaptive equipment must:

            (a) providing ongoing monitoring of the recipient's services relate specifically to and be primarily for the person’s disability;

            (b) intervening when necessary to ensure that the recipient's living situation continues to be healthy and safe, and that needs continue to be met have utility primarily for a person who has a disability;

            (c) conducting periodic assessments of risk in order to ensure that the intensive family support arrangement is appropriate and safe given the recipient's unique abilities and needs meet the specifications, if applicable, for the equipment set by the American National Standards Institute (ANSI);

            (d) assessing the recipient to determine the resources and services needed to carry out the individual plan; be prior authorized by the department if the cost of the project may exceed $4,000; and

            (e) developing, monitoring, and recording written plans of care in a way the recipient, caregivers, and others understand; be unavailable through any other sources.

            (f) meeting frequently with the recipient, and others, regarding the adequacy of the plan of care, how well the plan is being implemented, and changes which may be necessary in the plan;

            (g) teaching the recipient and caregivers to independently locate and establish contact with agencies who can assist them in securing the services they require in order to reduce reliance on the service system, generally, and on intensive support coordination, specifically;

            (h) facilitating interaction between people working in resource systems;

            (i) mobilizing and using natural helping networks such as family members, neighbors and friends;

            (j) providing inservice training to people providing habilitation, personal care, or other services to the recipient. Training includes general orientation and training on the specific needs of the recipient and how best to meet those needs;

            (k) managing personal as well as cost plan dollars to ensure that personal and service needs are met and that funds are efficiently utilized and accurately reported;

            (l) locating and arranging for suitable high quality housing, when necessary;

            (m) providing for adequate supervision of the recipient during the day, evening, and weekend;

            (n) hiring and supervising qualified staff to provide necessary services, with input from the recipient and caregivers;

            (o) subcontracting for services required by the plan of care;

            (p) ensuring that the recipient is free to choose a provider from among available qualified providers; and

            (q) requiring documentation of the service provided and for approving payment to direct service providers. 

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.926 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: INTENSIVE SUPPORT COORDINATION SERVICES, REQUIREMENTS ADULT COMPANION  (1) Intensive support coordination may only be provided by corporations under contract with the department. Adult companion services consist of nonmedical supervision and socialization provided to a person with a developmental disability. Companions may assist or supervise the person with tasks such as meal preparation, laundry, light housekeeping, and shopping but do not perform these activities as discrete services.

            (2) An intensive support coordinator must: Adult companion services must be provided in accordance with a therapeutic goal.

            (a) be certified as a family support specialist;

            (b) meet requirements specified by the contract with the department;

            (c) provide appropriate intensive support coordination services in the least costly manner; and

            (d) implement the plan of care.

            (3) The intensive support coordinator must ensure that the service is available on a 24 hour, 7 day a week basis.  Adult companion services may not be provided concurrent with:

            (a) persons in residential settings in which primary care is funded 24/7; or

            (b) with personal supports services.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.929 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: HOMEMAKER SERVICES, DEFINITIONS ADULT FOSTER  (1) Homemaker services are general household activities performed for persons who are unable to manage their home or care for self or others in the home and for whom there is no one else who can be responsible for these activities.  Adult foster support is a comprehensive service in which the person resides with an unrelated caregiver, licensed as an adult foster care provider, in order to receive support and supervision.

            (2) Homemaker services may include: A provider may provide service for up to four unrelated persons.

            (a) meal preparation, cleaning, simple household repairs, laundry, shopping for food and supplies and other routine household care;

            (b) household management services consisting of assistance with those activities necessary for maintaining and operating a home and may include assisting the recipient in finding and relocating in other housing; and

            (c) teaching services consisting of activities which will improve a recipient's or family's skills in household management and social functioning.

            (3)  Homemaker services do not include the provision of personal care services as defined in ARM 46.12.555 through 46.12.557. Room and board, items of comfort or convenience, or the cost of the maintenance and improvement of the facility are not included.

            (4) Adult foster support may not be provided concurrent with the following services:

            (a) personal supports;

            (b) live-in caregiver;

            (c) homemaker; or

            (d) personal care.

            (5) A provider of adult foster services must be licensed in accordance with 50-5-101 through 50-5-216, MCA and ARM 37.100.101 through 37.100.175.

            (6) A person may receive adult foster support independently or both adult foster support and residential training support.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.930 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: HOMEMAKER SERVICES, REQUIREMENTS ASSISTED LIVING  (1) A homemaker must be:  Assisted living is a congregate residential setting that provides or coordinates personal care, 24-hour supervision and assistance to meet the unpredictable needs of the person, activities, and health-related services.

            (a) able to follow written instructions;

            (b) able to communicate by the telephone; and

            (c) able to maintain records appropriate to the job assignment.

            (2) Assisted living is the provision of personal care, 24-hour supervision and assistance, and activities and health-related services.

            (3) Room and board, items of comfort or convenience, or the cost of the maintenance and improvement of the facility are not included.

(4)  Assisted living may not be provided concurrent with the following services:

(a) personal care;

(b) homemaker;

(c) residential habilitation;

(d) live-in caregiver;

(e) personal supports; and

(f) residential training supports.

(5) A provider of assisted living must be licensed according to the licensing requirements located in 50-5-101 and 50-5-225, MCA through 50-5-228, MCA, and ARM 37.106.2801 through 37.106.2908.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.933 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  PERSONAL CARE SERVICES, DEFINITIONS BEHAVIORAL SUPPORT SERVICES  (1) Personal care services are defined in ARM 46.12.555, except that under the Medicaid home and community services program personal care services may include supervision for health and safety reasons.  Behavioral support services teach others to carry out ethical and effective behavior interventions based on positive behavior supports. Behavioral support services staff may supervise the work of others who implement behavior interventions.

            (2) Behavioral support services may include:

            (a) designing behavioral assessments and functional analysis of behavior;

            (b) interpreting assessment and evaluation results for staff and unpaid caregivers;

            (c) designing, monitoring, and modifying written behavior support intervention procedures;

            (d) training staff and unpaid caregivers in the implementation of formal and informal behavioral support procedures; and

            (e) attending planning meetings for the purpose of providing guidance and information to plan team members.

            (3) A person providing behavioral support services must meet the requirements in ARM 37.34.1422(2).

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.934 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: PERSONAL CARE SERVICES, REQUIREMENTS CAREGIVER TRAINING AND SUPPORT  (1) A personal care attendant must be: Caregiver training and support (CTS) are services for unpaid caregivers who provide training, companionship, or supervision to a person with a developmental disability in a family setting or a private noncongregate residence.

            (a) able to follow written instructions;

(b) able to communicate verbally and in writing; and

            (c) able to maintain records appropriate to the job assignment.

            (2) Training for the caregiver may include:

            (a) instruction about treatment regimens;

            (b) use of specified equipment; and

            (c) updates as necessary to safely maintain the person at home.

            (3) Caregiver training and support (CTS) must be aimed at assisting the unpaid caregiver in meeting the needs of the person directly related to their role in supporting the person as identified in the plan of care.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.937 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: ADULT DAY SERVICES, DEFINITIONS COMMUNITY TRANSITION SERVICES (1) Adult day services are functional training services for the health, social, habilitation and supervision needs of a recipient provided in settings outside the person's place of residence. Community transition services are nonrecurring set-up expenses for a person who is transitioning from an institution to a Developmental Disabilities Program (DDP) waiver-funded home and community-based residential service.

            (2) Adult day services provided to an older recipient may be primarily for skill maintenance and the acquisition of skills that will enable the recipient to participate in a variety of age-appropriate activities supporting the goal of maintaining the recipient's ability to function in the community and to avoid institutionalization. The community transition service must be necessary to enable a person to establish a basic household.

            (3) Adult day services do not include residential overnight services.  Community transition services are furnished only to the extent that:

            (a) they are reasonable and necessary;

            (b) the person is unable to meet such an expense; or

            (c) the services cannot be obtained from other sources.

            (4) Community transition services may not include:

            (a) monthly rental or mortgage expense;

            (b) food;

            (c) regular utility charges;

            (d) household appliances; or

            (e) items that are intended for purely recreational purposes.

            (5) Community transition service is not available to a person transitioning into residential settings that are owned or leased by a Developmental Disabilities Program (DDP) funded service provider.

            (6) The residential setting must be owned, leased, or rented by the person and must be considered the person's private residence.

            (7) Community transition service may not exceed $3,000 per person, per transition.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.938 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: ADULT DAY SERVICES, REQUIREMENTS DAY SUPPORTS AND ACTIVITIES (1) An adult day service provider must employ staff experienced in providing services to persons with developmental disabilities, particularly to persons of advanced age. Day supports and activities consist of formalized habilitation services and staff support for the acquisition, retention, or improvement in self-help, behavioral, educational, socialization, and adaptive skills.

            (2) A provider must provide in-service training in first aid, CPR, behavior management and other identified needs. Day supports and activities are person-centered, preplanned, purposeful, documented, and scheduled activities which take place during typical working hours, in a nonresidential setting, separate from the private residence of the person or other residential living arrangements.

            (3) Day supports and activities may occur within a day activity setting, in the community, or in both settings. 

            (4) Day supports and activities may be provided as a continuous or intermittent service.

            (5) Day supports and activities must consist of community inclusion activities.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.941 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: HABILITATION SERVICES, DEFINITION ENVIRONMENTAL MODIFICATIONS  (1) Habilitation services are services that stimulate and maintain the development of a recipient's skills or that reduce behaviors which interfere with the recipient's development.  Environmental modifications are those physical adaptations to the home or vehicle which are necessary to safeguard the health, welfare, and safety of the person, or which enable the person to function with greater independence and without which the person would require institutionalization.

            (2) Habilitation services may include: An environmental modification must:

            (a) intense training required to alleviate severe skill deficits; relate specifically to and be primarily for a person with a disability;

            (b) on-going, supervised intervention for significant behavior problems; have utility primarily for a person who has a disability;

            (c) substantial care needed for medical problems which do not preclude habilitation; not be an item or modification that a family would normally be expected to provide for a nondisabled family member;

            (d) intensive daily care required because of the severity of the recipient's disability and provided by foster parents or other caregivers; not be in the form of room and board or general maintenance;

            (e) individual habilitation programs carried out by foster parents or other caregivers; meet the specifications, if applicable, for the modification set by the American National Standards Institute (ANSI); and

            (f) pre-vocational services; and be prior authorized by the department if the cost of the project may exceed $4,000.

            (g) supported employment services, which provide the opportunity to work for pay in regular employment, to integrate with non-disabled persons who are not paid caregivers, and to receive long term support in order to retain the employment.

            (3) Pre-vocational services, or work or day services as provided in ARM 37.34.2111 are services that support habilitative goals necessary for further vocational development. Pre-vocational services prepare a recipient for paid or unpaid employment. Pre-vocational services are not intended to develop specific job skills. Pre-vocational services may include:

            (a) training in self-help skills;

            (b) motor and physical development;

            (c) communication skills;

            (d) functional academics;

            (e) community life skills;

            (f) work skills; and

            (g) leisure skills.

            (4) Supported employment services may include:

            (a) pre-placement activities;

            (b) job market analysis/job development;

            (c) job match/screening;

            (d) job placement/training;

            (e) on-going assessment, support, and service coordination; and

            (f) transportation.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.942 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: HABILITATION SERVICES, REQUIREMENTS HOMEMAKER  (1) Habilitation services may be provided in the following settings: Homemaker services are general household activities performed when the person regularly responsible for these activities is unable to manage the home or care for self or others in the home or is engaged in providing habilitation and support services to the person with the developmental disability.

            (a) residential settings. Residential settings include:

            (i) community homes for adults;

            (ii) community homes for children;

            (iii) foster homes; and

            (iv) the recipient's own home.

            (b) day settings. Day settings include:

            (i) day services;

            (ii) prevocational services; and

            (iii) supported employment, otherwise referred to as supported work services.

            (2) Prevocational and supported employment services may be provided to only those recipients who formerly resided an ICF/MR or a nursing facility. Homemaker services may include meal preparation, cleaning, simple household repairs, laundry, shopping for food and supplies, and other routine household care.

            (3) Prevocational services may be provided only to those recipients: Homemaker services do not include the provision of personal care services as described in ARM 37.34.957.

            (a) who are compensated for the work they do at a rate that is less than 50% of minimum wage; and

            (b) who are not expected to be able to join the general work force within 1 year.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.946 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  RESPITE CARE, DEFINITION INDIVIDUAL GOODS AND SERVICES  (1) Respite care services are services provided to a recipient so as to temporarily relieve those persons normally caring for the recipient from the responsibility for the care of the recipients. Individual goods and services are services, supports, or goods that enhance opportunities to achieve outcomes related to living arrangements, relationships, and inclusion in the community as identified and documented in the plan of care.

            (2) Individual goods and services must fall into one of the following categories:

            (a) memberships and fees; or

            (b) equipment and supplies.

            (3) Individual goods and services must be:

            (a) exclusively for the benefit of the person; and

            (b) the most cost-effective alternative that reasonably meets the assessed need of the person.

            (4) The service, equipment, or supply must meet the person's medical needs or provide support in order to be independent in daily activities and must meet one of the following criteria:

            (a) promotes inclusion in the community;

            (b) increases the person's safety in the home environment; or

            (c) decreases the need for other Medicaid services.

            (5) The cost of the service, equipment, or supply must not compromise the person's health or safety by depleting their individual cost plan to the extent they cannot receive services that provide for their health and safety.

            (6) Service, equipment, or supplies which are experimental will not be reimbursed.

            (7) A person or the person's delegate self-directing services with employer authority using the financial management service (FMS) option must purchase goods and services in accordance with the requirements set forth by the Developmental Disabilities Program (DDP) and receive reimbursement from the fiscal management service.

            (8) Individual goods and services expected to exceed a $2,000 annual aggregate limit require prior approval by the DDP regional manager.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.947 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  RESPITE CARE, REQUIREMENTS JOB DISCOVERY  (1) A respite care provider must be aware of emergency assistance systems. Job discovery is individual assistance to identify supports and develop employment goals and a career profile or career plan for achieving integrated employment. Career profiles or career plans may be developed through various strategies such as job exploration, job shadowing, informational interviewing, job and task analysis activities, employment preparation, business plan development for self-employment, and volunteerism.

            (2) Respite care providers may be required by the intensive support coordinator or the supported living coordinator to be: Job discovery is limited to 40 hours of service per year, unless additional hours are prior approved by the Developmental Disabilities Program (DDP).

            (a) knowledgeable of the physical and mental conditions of the recipient;

            (b) knowledgeable of the common medications and related conditions of the recipient; and

            (c) capable of administering basic first aid.

            (3) Respite care may be provided in a recipient's place of residence, in another private residence, or in an appropriate community setting. Job discovery may be provided in conjunction with other employment services.

(4) Agency-based services may be provided in:

(a) a community setting; or

(b) a developmental disability legal entity site.

            (5) Self-directed service options must be provided in a community setting with 1:1 staff ratio.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.950 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  OCCUPATIONAL THERAPY SERVICES, DEFINITION JOB PREPARATION  (1) Occupational therapy services are defined in ARM 46.12.545, except that under the Medicaid home and community services program outpatient occupational therapy services may be provided for: Job preparation provides formalized training and work experiences, based upon the goals identified during job discovery, intended to teach a person the skills necessary to succeed in a paid competitive, customized, or self-employment setting. Training may also address workplace social skills and the development of practices and behaviors necessary for successful employment.

            (a) habilitation;

            (b) maintenance; or

            (c) training for persons providing direct care.

            (2) Job preparation must be primarily for the purpose of habilitation.

            (3) If the person has not obtained integrated employment after two years of receiving job preparation, the job discovery process must be repeated.

            (4) Job preparation may be provided in conjunction with other employment services.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.951 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: OCCUPATIONAL THERAPY SERVICES, REQUIREMENTS LIVE-IN CAREGIVER (1) Occupational therapy must meet the requirements for occupational therapy services required by ARM 46.12.546, except that under the Medicaid home and community services program: Live-in caregiver services provide support to enable a person to live independently and participate in community activities to the fullest extent possible. The live-in caregiver assists with implementing the needed supports as identified in the plan of care which enable the person to retain or improve skills related to health, activities of daily living, money management, community resources, community safety, and other adaptive skills needed to live in the community.

            (a) maintenance therapy is reimbursable;

            (i) there is not a limitation on visits for maintenance therapy;

            (b) training for persons providing direct care is reimbursable; and

            (c) participation in the interdisciplinary team planning process is reimbursable.

            (2) Live-in caregiver services cannot be provided in the caregiver's private residence or in a residence that is owned or leased by a Montana Medicaid provider.

            (3) Live-in caregiver services must include an approved back-up plan in the event of service disruption.

            (4) Terms and conditions of the service must be specified in a written live-in caregiver agreement between the legal entity, the live-in caregiver, and the person receiving the service and approved by the department.

            (5) Parents or legal representatives may not be reimbursed for live-in caregiver services.

            (6) Live-in caregiver services are reimbursed a daily room and board stipend.

            (7) The annual cap for live-in caregiver services is $9,000.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.954 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: PHYSICAL THERAPY SERVICES, DEFINITION MEALS  (1) Physical therapy services are defined in ARM 46.12.525, except that under the Medicaid home and community services program physical therapy services may provide for: Meal services provide hot or other appropriate meals once or twice a day, up to seven days a week, to ensure that a person receives adequate nourishment and to prevent institutional placement.

            (a) habilitation;

            (b) maintenance; or

            (c) training for persons providing direct care.

            (2) Physical therapy treatment training programs may include: Meal services may only be provided to a person who is not eligible to receive meals from any other source, or who need different or more extensive services than are otherwise available.

            (a) preserving and improving abilities for independent function, such as range of motion, strength, tolerance, coordination and activities of daily living; and

            (b) preventing, insofar as possible, irreducible or progressive disabilities through means such as the use of orthotic prosthetic appliances, assistive and adaptive devices, positioning, behavior adaptations and sensory stimulation. 

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.955 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: PHYSICAL THERAPY SERVICES, REQUIREMENTS NUTRITIONIST  (1) Physical therapy must meet the requirements of ARM 46.12.526, except that under the Medicaid home and community services program: Nutritionist services are services related to the management of a person's nutritional needs and include:

            (a) maintenance therapy may be reimbursed; meal planning;

            (i) there is not a limitation on visits for maintenance therapy;

            (b) training for persons providing direct care is reimbursable; and consultation with and training for persons providing direct care; and

            (c) participation in the interdisciplinary team planning process is reimbursable education for the person receiving the service.

            (2) Nutritionist services do not include the provision of meals.

            (3) Nutritionists must meet the licensing requirements in Title 37, chapter 25, part 3, MCA.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.956 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: SPEECH THERAPY SERVICES, DEFINITION OCCUPATIONAL THERAPY  (1) Speech therapy services are defined in ARM 46.12.530, except that under the Medicaid home and community services program speech therapy services may be provided for: Occupational therapy is as defined in 37-24-103(5), MCA.

            (a) habilitation;

            (b) maintenance; or

            (c) training for persons providing direct care.

            (2) Providers of occupational therapy services must be licensed in accordance with the rules and regulations governing the profession.

            (3) Occupational therapy must be provided through direct contact with a licensed therapist and the person or to train persons working directly with the person receiving the service.

            (4) Occupational therapists may provide evaluation, consultation, training, and treatment.

            (5) Occupational therapy may be provided when required occupational therapy services exceed Montana state plan or are different from the services available in the Montana state plan.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.957 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: SPEECH THERAPY SERVICES, REQUIREMENTS PERSONAL CARE  (1) Speech therapy must meet the requirements of ARM 46.12.531, except that under the Medicaid home and community services program: Personal care services provide medically necessary in-home services to persons who are functionally limited in performing activities of daily living.

            (a) maintenance therapy may be reimbursed;

            (i) there is not a limitation on visits for maintenance therapy;

            (b) training for persons providing direct care is reimbursable; and

            (c) participation in the interdisciplinary planning process is reimbursable. 

            (2) Personal care services may include:

            (a) assistance with personal hygiene, dressing, eating, and ambulatory needs;

            (b) household tasks incidental to the health care needs of the person or otherwise necessary to maintain the person in the home; and

            (c) supervision for health and safety reasons.

            (3) Personal care services may be provided when the required personal care services exceed the Montana state plan or are different from the services available in the Montana state plan.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.960 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: ENVIRONMENTAL MODIFICATIONS, DEFINITIONS PERSONAL EMERGENCY RESPONSE SYSTEM  (1) Environmental modifications services are measures that provide the recipient with accessibility and safety in the environment so as to maintain or improve the ability of the recipient to remain in community settings and employment. Personal emergency response system (PERS) is an electronic device that enables the person to secure help in an emergency. The system is connected to the person's phone and programmed to signal a response center once a help button is activated. The response center is staffed by trained professionals. PERS services may be appropriate for persons who live alone, or who are alone for parts of the day, and have no regular caregiver for periods of time.

            (2) Environmental modifications may be made to a recipient's home or vehicle for the purpose of increasing independent functioning and safety or to enable family members or other caregivers to provide the care required by the recipient. PERS service may be delivered via a cellular phone.

            (3) To access the cellular phone option, the person must:

            (a) require access to assistance or supports; and

            (b) frequently be beyond the range of coverage of a PERS system.

            (4) Cell phone plans must be basic plans and must not include features or applications unrelated to health and safety issues.

            (5) A usage control feature and insurance may be added to the basic plan.

            (6) The person must pay any overage fee and any other fees that are not approved in the plan of care.

            (7) The case manager must review the cell phone guidelines with the person upon receipt of the phone and at the annual planning meeting.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.961 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: ENVIRONMENTAL MODIFICATIONS, REQUIREMENTS PERSONAL SUPPORTS  (1) An environmental modification provided to a recipient must: Personal supports service assist the person in carrying out daily living tasks and other activities essential for living in the community and provide supervision and monitoring to ensure the person's health and safety.

            (a) relate specifically to and be primarily for the recipient's disability;

            (b) have utility primarily for a person who has a disability;

            (c) not be an item or modification that a family would normally be expected to provide for a nondisabled family member;

            (d) not be in the form of room and board or general maintenance;

            (e) meet the specifications, if applicable, for the modification set by the American national standards institute (ANSI); and

            (f) be prior authorized jointly by the provider's board of directors and the department if the cost of the project may exceed $4,000.

            (2) Personal supports may assist the person with:

            (a) ensuring the person's health and safety;

            (b) accessing the community;

            (c) development of self-advocacy skills;

            (d) identifying and sustaining a personal support network;

            (e) household activities necessary to maintain the home-living environment;

            (f) home maintenance activities;

            (g) maintaining employment; and

            (h) accessing opportunities.

            (3) Personal supports may only be provided to a person self-directing services.

            (4) Waiver services which overlap with the activities of personal supports may not be provided concurrently with personal supports including:

            (a) live-in caregiver;

            (b) adult companion;

            (c ) extended personal care services; and

            (d) homemaker services.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.962 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: ADAPTIVE EQUIPMENT, DEFINITIONS PHYSICAL THERAPY  (1) Adaptive equipment is equipment necessary to increase the ability of a person with a disability to function independently in community settings and employment. Physical therapy is as defined in 37-11-101(7), MCA.

            (2) Providers of physical therapy services must be licensed in accordance with the rules and regulations governing the profession.

            (3) Physical therapy must be provided through direct contact with the therapist and the person or to train persons working directly with the person receiving the service.

            (4) Physical therapist may provide supports that:

            (a) improve or preserve abilities of independent functioning; and

            (b) prevent, in as much as possible, chronic or progressive conditions.

            (5) Physical therapy may be provided when required physical therapy services exceed the Montana state plan or are different from the services available in the Montana state plan.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.963 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: ADAPTIVE EQUIPMENT, REQUIREMENTS PRIVATE DUTY NURSING  (1) Adaptive equipment provided to a recipient must: Nursing services are defined in 37-18-102, MCA.

            (a) relate specifically to and be primarily for the recipient disability;

            (b) have utility primarily for a person who has a disability;

            (c) meet the specifications, if applicable, for the equipment set by the American national standards institute (ANSI);

            (d) be prior authorized jointly by the provider's board of directors and the department if the cost of the project may exceed $4,000;

            (e) not be available to the recipient through other sources.

            (2) Providers of nursing services must be licensed in accordance with the rules and regulations governing the profession.

            (3) A person receiving the private duty nursing must be 21 years of age or older.

            (4) Private duty nursing may be provided when the required nursing services exceed the Montana state plan or are different from the services available in the Montana state plan.

            (5) Private duty nursing must be provided in the location where the person needs the service.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.967 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: TRANSPORTATION AND ESCORT SERVICES, DEFINITION PSYCHOLOGICAL AND COUNSELING SERVICES (1) Transportation services are services furnished by common transportation carrier or private vehicles to transport recipients for needed services or social activities. Psychological and counseling services are those services provided by a licensed psychologist, licensed professional counselor, or a licensed clinical social worker within the scope of the practice of the respective professions.

            (2) Escort services are accompaniment for purposes of providing guidance and assistance. Service definitions for each profession may be found at the following:

            (a) licensed psychologist, 37-17-102(4), MCA;

            (b) licensed professional counselor, 37-23-102(3), MCA; and

            (c) licensed clinical social worker, 37-22-102(5), MCA.

            (3) Psychological and counseling services may include:

            (a) individual or group therapy;

            (b) consultation with providers and caregivers;

            (c) development and monitoring of behavior programs;

            (d) participation in the individual planning process; and

            (e) counseling for primary caregivers.

            (4) Psychological and counseling services are available to adults when the service is:

            (a) recommended by a qualified professional;

            (b) approved by the planning team; and

            (c) written into the plan of care.

            (5) Psychological and counseling services may be provided when the required nursing services exceed the Montana state plan or are different from the services available in the Montana state plan.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.968 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: TRANSPORTATION AND ESCORT SERVICES, REQUIREMENTS REMOTE MONITORING (1) Transportation providers must have: Remote monitoring provides oversight and monitoring within a residential setting through off-site electronic surveillance, while maintaining the health and safety of the person receiving the service.

            (a) a valid Montana driver's license;

            (b) adequate automobile insurance as determined by the department; and

            (c) assurance of vehicle compliance with all applicable federal, state and local laws and regulations.

            (2) Transportation and escort services must be provided by the most cost effective mode.  Remote monitoring must be done in real time, by awake staff, at a monitoring base using:

            (a) live video feed;

            (b) motion sensing systems;

            (c) radio frequency identification;

            (d) web-based monitoring systems; or

            (e) other devices approved by the Developmental Disabilities Program (DDP).

            (3) The person receiving remote monitoring must be 18 years of age or older.

            (4) The remote monitoring staff must not participate in other duties while providing remote monitoring.

            (5) The provider must have an effective emergency notification system in place to respond to any emergency within a reasonable time. The emergency response system must be written in the plan of care and must include:

            (a) the circumstances in which backup supports must be contacted;

            (b) the expected timeframes in which backup supports must respond; and

            (c) if the response must be in person or by other means of contact, including notification to emergency responders such as police, fire, and medical services.

            (6) Live two-way communication may be provided if it is designated in a person's plan of care.

            (7) The case manager must fully inform the person or their legal representative and each person who resides with the person of what remote monitoring entails and obtain written consent from each person. The case manager must keep the written consent with the person's plan of care.

            (8) Remote monitoring may only be used in supported living settings with the purpose of:

            (a) reducing or replacing the amount of residential habilitation needed by the person; or

            (b) preventing the need for additional residential habilitation.

            (9) Remote monitoring providers must have a backup power supply in place at the monitoring base in the event of an electrical outage.

            (10) Service documentation must fully disclose the nature and extent of the services delivered and be signed by the person delivering the service.

            (11) The provider of remote monitoring must disclose the current ratio of monitoring staff to persons receiving remote monitoring to the person's plan of care team during the provider selection process and update the information annually and as changes occur.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.971 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: PSYCHOLOGICAL AND PROFESSIONAL COUNSELING SERVICES, DEFINITION REMOTE MONITORING EQUIPMENT (1) Psychological services are defined in ARM 46.12.580 except that under the Medicaid home and community services program, psychological services may include: Remote monitoring equipment is the equipment used to operate systems such as live feed video, live audio feed, motion sensing system, radio frequency identification, web-based monitoring system, or other devices approved by the Developmental Disabilities Program (DDP). It also refers to the equipment used to engage in live two-way communication with the person being monitored.

            (a) consultation with persons providing direct care;

            (b) development and monitoring of behavior programs; and

            (c) counseling to persons caring directly for the recipient when the caregiver's counseling needs are related to the responsibilities of the caregiving relationship.

            (2) Professional counseling services are defined at ARM 46.12.620 except that under the Medicaid home and community services program, professional counseling services may include: Remote monitoring equipment must include an indicator to the person being monitored that the equipment is on and operating. The indicator must be appropriate to meet the person's needs.

            (a) consultation with persons providing direct care;

            (b) development and monitoring of behavior programs; and

            (c) counseling to persons caring directly for the recipient when the caregiver's counseling needs are related to the responsibilities of the caregiving relationship.

            (3) Remote monitoring equipment must be designed to be turned off only by the person indicated in the plan of care.

            (4) The provider of remote monitoring equipment must be responsible for the following:

            (a) delivery of equipment to the person's residence and as needed to the room or area of the residence in which the equipment will be used;

            (b) assembly and installation of the equipment, as appropriate for correct operation;

            (c) adjustment and modification to the equipment, as needed;

            (d) conduct monthly testing of the equipment to ensure proper operation;

            (e) maintain and repair equipment, as necessary; and

            (f) replace equipment at any time for any reason other than misuse or damage by the person receiving the service.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.972 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: PSYCHOLOGICAL AND PROFESSIONAL COUNSELING SERVICES, REQUIREMENTS RESIDENTIAL HABILITATION  (1) Psychological services must be provided by a psychologist licensed as provided in ARM 8.52.601, et seq. Residential habilitation services support persons in acquiring, retaining, and improving self-help, social, and adaptive skills necessary to reside successfully in home and community-based settings.

            (2) Psychological services must meet the requirements of ARM 46.12.581 except under the Medicaid home and commun­ity services program. The service includes caregiving, skills training, and supervision to a person in a noninstitutional setting. The degree and type of care, supervision, and skills training is based on the person's needs and must be identified in the plan of care.

            (3) Professional counseling services must be provided by a professional counselor licensed as provided in ARM 8.61.1201, et seq. Training may be provided in basic self-help, home and community living, and leisure and social skills.

            (4) Professional counselor services must meet the requirements of ARM 46.12.622. Each training objective must be specified in the plan of care and related to the long-term goals of the person.

            (5) Residential habilitation must be provided where the person lives. Settings include:

            (a) group homes;

            (b) congregate and noncongregate living apartments; and

            (c) natural homes. 

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.973 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM:  NURSING SERVICES, DEFINITION RESIDENTIAL TRAINING SUPPORT  (1)  Nursing services are defined in 37-8-102, MCA. Residential training support provides training to increase the person's independence in health care, self-care, safety, and access to community services.

            (2) Nursing services may include: Residential training supports are available to a person receiving adult foster support service in accordance with assessed needs and as identified by the person in the plan of care.

            (a) medical management;

            (b)  direct treatment;

            (c) consultation; and

            (d) training for the recipient or persons providing direct care.

            (3) Residential training supports may only be provided when delivered in a licensed adult foster home funded under adult foster supports.

            (4) If the provider of the adult foster support service is not qualified to provide residential training supports, the service must be made available by a qualified employee of an agency under contract with the Developmental Disabilities Program (DDP).

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.974 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: NURSING SERVICES, REQUIREMENTS RESPITE  (1) Nursing services must be provided by a registered nurse or licensed practical nurse. Respite care is relief services designed to allow family members, who regularly care for the person receiving waiver services, to be relieved from their caregiver responsibilities in relation to reducing stress generated by the provision of constant care to the person receiving waiver services.

            (2) Persons providing nursing services must meet the licensure and certification requirements provided in ARM 8.32.401, et seq. Respite providers must be selected and trained by the parents or legal representatives of the person.

            (3) Nursing services may be provided to a recipient in the recipient's home, or at a vocational or day activity setting.  Respite care may be provided in:

            (a) a licensed children's day care center and in a licensed family and group day care home for children from birth through age 12;

            (b) a licensed children's day care center and in a licensed family and group day care home for children age 13 through age 17; and

            (c) a licensed adult day center for a person 18 and older.

            (4) The waiver will pay the difference in cost between usual and customary rates and the increased rate charged by the provider, as described in (3), to serve a child with extraordinary support needs for children under the age of 13.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.978 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: DIETITIAN SERVICES, DEFINITION RETIREMENT SERVICES  (1) Dietitian services are services related to the management of a recipient's nutritional needs and include: Retirement services are available to a person who is age 62 or older, or who is limited due to health and safety issues. Retirement services are structured services consisting of day activities and residential support. Retirement services are furnished in a way which fosters the independence of each person.  Retirement services are person-centered and person-directed to the maximum extent possible.

            (a) meal planning;

            (b) consultation with and training for persons providing direct care; and

            (c) education for the recipient.

            (2) Dietitian services do not include the provision of meals. Retirement services may be provided as a continuous or intermittent service.

            (3) Retirement services must be provided in a residential or community day activity setting.

            (4) The expected outcome of retirement services is to:

            (a) maintain skills and abilities to the maximum extent possible;

            (b) keep the person engaged in their environment and community; and

            (c) provide supervision, safety, and security.

            (5) In a provider-operated residence, only shared living spaces such as the living room, kitchen, bathroom, and recreational areas may be utilized to provide retirement services.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.979 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: DIETITIAN SERVICES, REQUIREMENTS SPEECH THERAPY (1) Dietitian services must be provided by a registered dietitian or a licensed nutritionist. Speech therapy is as defined in 37-15-102, MCA.

            (2) Dietitians must meet the qualifications in 37-21-301 et seq., MCA. Providers of speech therapy services must be licensed in accordance with the rules and regulations governing the profession.

            (3)  Nutritionists must meet the licensing requirements in 37-25-301 et seq., MCA. Speech therapy must be provided through direct contact with the therapist and the person or to train persons working directly with the person receiving the service.

            (4) Reimbursement is not available for the cost of food items and meal preparation. A speech therapist may provide:

            (a) screening and evaluation with respect to speech and hearing functions;

            (b) comprehensive speech and language evaluations when the screening indicates it is necessary;

            (c) continuing interdisciplinary evaluation for the purpose of beginning, monitoring, and following up in regards to habilitation programs; and

            (d) treatment services designed to develop specialized programs for communication.

            (5) Speech therapy may be provided when required speech therapy services exceed the Montana state plan or are different from the services available in the Montana state plan.

 

AUTH: 53-2-201, 53-6-113, 53-6-402, 53-20-204, MCA

IMP:     53-2-201, 53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.980 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: MEAL SERVICES, DEFINITIONS SUPPORTED EMPLOYMENT, FOLLOW ALONG SUPPORT  (1) Meal services provide hot or other appropriate meals once or more a day, up to 7 days a week, to ensure that a recipient receives adequate nourishment and to prevent institutional placement. Follow along support consists of habilitation services and supports that enable a person to stabilize or expand employment in a competitive, customized, or self-employment setting.

            (2) The person may require follow along support when:

            (a) the person's job is in jeopardy; or

            (b) a job promotion opportunity requires more complex, comprehensive, or intensive supports.

            (3) Follow along support may be provided in an extended ongoing manner or intermittently as needed.

            (4) Follow along support may include:

            (a) person-centered employment planning;

            (b) job promotion activities;

            (c) observation and job support to enhance job task skills;

            (d) monitoring at the work site to ascertain the success of the job placement;

            (e) job coaching;

            (f) follow up with the employer, coworkers, employed person, parents, legal representatives, and others as needed, in order to reinforce and stabilize job placement;

            (g) facilitation of natural supports at the work site;

            (h) advocating for the person at the employment site;

            (i) assistance with management of financial paperwork;

            (j) assistance with medication administration considered incidental to the follow along support;

            (k) application of behavioral intervention programs, when developed and approved according to the positive behavioral support rule.

            (5) Follow along support may be provided in conjunction with other employment services.

 

AUTH:    53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.981 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: MEAL SERVICES, REQUIREMENTS SUPPORTED EMPLOYMENT, INDIVIDUAL EMPLOYMENT SUPPORT  (1) Meal services may only be provided to recipients who are not eligible to receive meals from any other source, or who need different or more extensive services than are otherwise available. Individual employment supports are habilitation services and staff supports needed by a person to acquire integrated employment or career advancement in the general workforce. Individual employment support is delivered in a competitive, customized, or self-employment setting. The outcome of this service is paid employment in a competitive, customized, or self-employment setting within the general workforce that meets the person's personal and career goals, as documented in the plan of care.

            (2) A full nutritional regimen of 3 meals per day may not be provided as a home and community services. Individual employment supports may include:

            (a) person-centered employment planning;

            (b) job development;

            (c) negotiation with prospective employers;

            (d) creating a job description based on a task derived from a single traditional job (job carving);

            (e) job placement;

            (f) support for career advancement opportunities;

            (g) job analysis;

            (h) training, support, coordination, and communication in related skills needed to obtain or retain employment;

            (i) job coaching;

            (j) job loss support; and

            (k) benefit planning support.

            (3) Individual employment supports may be provided in conjunction with other employment services.

 

AUTH:    53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.985 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: SUPPORTED LIVING COORDINATION, DEFINITION SUPPORT EMPLOYMENT, SMALL GROUP SUPPORT  (1) Supported living coordination activities include: Small group employment support consists of habilitation services and staff supports needed for groups of two to eight workers with disabilities to acquire and maintain a job or position in the general workforce.

            (a) teaching the recipient and caregivers to independently locate and establish contact with agencies who can assist them in securing the services they require in order to reduce reliance on the service system, generally and on supported living coordination, specifically;

            (b) providing in-service training to those people providing habilitation, personal care, or other services to the recipient;

            (c) managing personal as well as plan costs to ensure that personal and service needs are met and that funds are efficiently utilized and accurately reported;

            (d) providing for adequate supervision of the recipient during the day, evening and weekend;

            (e) hiring and supervising qualified staff to provide supported living services, with input from the recipient and caregivers;

            (f) subcontracting for services required by the plan of care;

            (g) conducting periodic assessments of risk in order to ensure that the supported living arrangement is appropriate and safe given the recipient's unique abilities and needs;

            (h) conducting individual assessments specifically related to the supported living service. These assessments will not duplicate assessments completed by developmental disabilities case managers in scope or type of data collected;

            (i) arranging for suitable high quality housing, when necessary;

            (j) ensuring that the recipient is free to choose a provider from among available qualified providers; and

            (k) requiring documentation of the service provided and for approving payment to direct service providers.

            (2) Small group employment support must be provided in a manner that promotes integration into the workplace and interaction between people with and without disabilities in those workplaces.

            (3) Small group employment support must occur in business settings during the hours typical for the industry.

            (4) Small group employment support may include:

            (a) person-centered employment planning;

            (b) job development;

            (c) negotiation with prospective employers;

            (d) creating a job description based on a task derived from a single traditional job (job carving);

            (e) job placement;

            (f) support for career advancement opportunities;

            (g) job analysis;

            (h) training, support, coordination, and communication in related skills needed to obtain or retain employment;

            (i) job coaching; and

            (j) benefit planning support.

            (5) Small group employment support may be provided in conjunction with other employment services.

 

AUTH:    53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.986 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: SUPPORTED LIVING COORDINATION, REQUIREMENTS SUPPORT EMPLOYMENT, COWORKER SUPPORT  (1) Supported living coordination may only be provided by corporations under contract with the department. Coworker support service allows the Developmental Disabilities Program (DDP) and developmental disabilities provider agencies to contract with a business to provide coworker job supports as a part of the natural workplace. This service differs from supported employment, follow along support in that it creates opportunity for services and supports to be provided by the employee of a local business where the person is employed. This service is intended to provide ongoing coworker support allowing follow along support to be decreased.

            (2) A supported living coordinator must have:  The purpose of supported employment coworker support is to assist the person to:

            (a) a B.A. degree from an accredited college in a human service related field; and develop positive work-related habits, attitudes, and skills;

            (b)  one year of experience working with people with developmental disabilities; or acquire work etiquette directly related to their specific employment;

            (c) an equivalent combination of education and experience. gain knowledge of the health and safety aspects/requirements of their particular job;

            (d) assist the person in becoming a part of the informal culture of the workplace;

            (e) provide job skill maintenance or assistance with incorporating new tasks; and

            (f) facilitate other supports at the work site.

            (3) A supported living coordinator must: Coworker support may be provided in conjunction with other employment services.

            (a) provide appropriate intensive support coordination services in the least costly manner; and

            (b) ensure implementation of the plan of care.

            (4) Providers of supported living coordination must ensure that the service is available on a 24 hour, 7 day a week basis.  The employer is reimbursed a daily rate to offset the cost to the employer for providing the supports which may be needed to maintain the person in the job.

 

AUTH:    53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.987 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: RESPIRATORY SERVICES, DEFINITION SUPPORTS BROKERAGE  (1) Respiratory services include direct treatment, ongoing assessment of medical condition, equipment monitoring and upkeep, pulmonary education and rehabilitation. Supports brokerage services assist the person self-directing service with employer authority in arranging, directing, and managing self-directed services as described in the person's plan of care. The supports broker acts as an agent of the person or legal representative and is available to assist in identifying immediate and long-term needs, developing options to meet those needs, and accessing identified supports and services.

            (2) As determined by the scope and nature of the opportunities afforded to the person in waiver services, supports brokers may provide information regarding the following:

            (a) person-centered planning and how it is applied;

            (b) the range and scope of the choices and options the person has;

            (c) the process for changing the plan of care and the individual budget;

            (d) the grievance process;

            (e) risks and responsibilities of self-direction;

            (f) freedom of choice of providers;

            (g) reassessment and review of schedules; and

            (h) other information pertinent to managing self-directed services.

            (3) The supports broker may assist the person with:

            (a) defining goals, needs, and preferences;

            (b) training the person on the material contained in the self-directed employer handbook;

            (c) day-to-day management of the budget for self-directed services;

            (d) identifying and accessing services, support, and resources;

            (e) practical skills training regarding hiring, managing, and terminating employees;

            (f) problem solving and conflict resolution;

            (g) development of risk management agreements;

            (h) development of an emergency backup plan;

            (i) exercising independent advocacy;

            (j) completing required forms; and

            (k) development and maintenance of service documentation.

            (4) Duplicative services are not allowed concurrent with supports brokerage. In instances where activities of the supports broker duplicate the provisions of case management, the plan of care must clearly delineate the responsibilities for performance activities.

            (5) The annual cap for supports brokerage is the lesser of $6,000 or 20% of the value of the individual cost plan (ICP). These values may be exceeded for a limited time period in extraordinary circumstances with prior approval of the Developmental Disabilities Program (DDP) director.

 

AUTH:    53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-6-101, 53-6-402, 53-20-205, MCA

 

            37.34.988 0208 MEDICAID HOME AND COMMUNITY-BASED SERVICES PROGRAM: RESPIRATORY SERVICES, REQUIREMENTS TRANSPORTATION  (1) Respiratory therapy services must be provided by a registered respiratory therapist as defined by the national board for respiratory care. Transportation services are those services which enable persons served in the waiver to gain access to waiver and other community services, activities, and resources.

            (2) Transportation may be offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the state plan, defined at 42 CFR 440.170(a).

            (3) Reimbursable transportation expenses may include assistance with reasonable costs related to one or more of the following areas, as determined by the Developmental Disabilities Program (DDP):

            (a) operator training and licensure;

            (b) insurance; and

            (c) registration or other costs associated with a person's dependence on the use of a personal vehicle as outlined in the plan of care.

            (4) The following are excluded from transportation services:

            (a) adaptations or improvements to the vehicle that are of general utility, and are not of direct medical or remedial benefit to the person;

            (b) purchase or lease of a vehicle;

            (c) regularly scheduled upkeep and maintenance of a vehicle with the exception of upkeep and maintenance of any modifications; and

            (d) escort services.

            (5)  For self-directed services, the financial management service (FMS) may only pay mileage reimbursement upon receiving documentation that transportation was provided in accordance with Montana state requirements for operating a motor vehicle.

            (6) Mileage reimbursement through the FMS may be available to the owner of the vehicle when:

            (a) transportation services to the person are for approved community functions;

            (b) all the requirements for operating a motor vehicle that are required have been met; and

            (c) the mileage reimbursement provision is approved in the plan of care.

            (7) A person with employer authority using the FMS option may only be reimbursed for mileage.

            (8) Transportation may be provided when required transportation services exceed the Montana state plan or are different from the services available in the Montana state plan.

            (9) Legal representatives and other persons who are not employees of agencies with a Developmental Disabilities Program (DDP) contract may be reimbursed for the provision of rides at the mileage rate based on the operational expense of a motor vehicle but does not include:

            (a) reimbursement for work performed;

            (b) the driver's time; or

            (c) transportation not directly related to the specific disability needs of a person, as outlined in the plan of care.

            (10) A person providing transportation services must:

            (a) be 18 years of age or older;

            (b) have a valid motor vehicle license;

            (c) maintain liability insurance; and

            (d) have proof of vehicle registration.

 

AUTH:    53-6-113, 53-6-402, 53-20-204, MCA

IMP:      53-6-101, 53-6-402, 53-20-205, MCA

 

            5. STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) is proposing to adopt new rules and amend rules that pertain to Montana Medicaid Home and Community-Based Services Program.

 

The proposed rule amendments are necessary to conform state authority for administration of the 0208 Home and Community-Based Services (HCBS) Waiver Program with the current agreement with the federal Centers for Medicare and Medicaid Services (CMS) that govern the state's program; to place the various details for the management of the program into rule; and to initiate certain new services and changes in existing services.

 

In order to continue to provide appropriate and effective services to persons with a developmental disability, the Department of Public Health and Human Services, Developmental Services Division, Developmental Disabilities Program (DDP) submitted a 1915(c) Home and Community-Based Services Waiver renewal application to the CMS which was effective July 1, 2013. The purpose of this program is to provide an array of home and community-based services that assist persons with a developmental disability to live in the community and avoid institutionalization. The department has broad discretion in the design of the waiver program to address the needs of the waiver target population through the development of a range of services that are necessary and appropriate for meeting those needs. The proposed amendments to Administrative Rules of Montana, ARM Title 37, chapter 34, subchapter 9, are specific for administering the 1915(c) HCBS Waiver services as renewed with CMS approval of the 0208 HCBS Waiver Program.

 

The 0208 HCBS Waiver Program now serves persons who previously received home and community waiver services through the 0371 Community Supports Waiver which has been terminated effective July 1, 2013 by the department. A person who received 0371 waiver services will continue to receive current services but will do so now in accordance with the governing authorities for the 0208 Waiver Program and potentially will have access to the greater array of services in the 0208 Waiver Program.

 

The rules define the population eligible to be served; provides selection and entry criteria and procedures; specifies the services available under the program; and specifies the provider requirements. The development and use of the rule to comprehensively state all the features and requirements for service delivery and governance such as personal eligibility, service availability, description, and delivery requirements, is necessary to provide a singular document of reference for persons receiving services, families, providers, and other members of the public. 

 

New Rule I and ARM 37.34.925 through 37.34.988

 

New Rule I and ARM 37.34.925 through 37.34.988 pertain to the particular services available through the 0208 HCBS Waiver Program and specifies the available services along with the various requirements pertaining to their utilization. The services to be made available through the 0208 HCBS Waiver Program have been modified to be consistent with CMS approval.  Formatting of the rules has been amended to assign one rule number per service to define and state the requirements for each service. Staff/provider training, licensing, certification, and education requirements specific to each service have been added via the matrix adopted and incorporated in ARM 37.34.912.

 

The key changes for the waiver program renewal, as noted in the approval letter from the CMS and which appear in the text of the rule, are as follows:

 

            (1) Intensive support coordination and supported living coordination are no longer available services.

            (2) Habilitation services: the current definition and requirements for day habilitation have been removed. The habilitation service is unbundled and replaced with day supports and activities and job discovery/job preparation services. This is necessary to provide for more effective integrated services and allow for more accurate billing.

            (3) Adult day services has been removed and replaced with retirement services.

            (4) Respiratory services: respiratory therapy is removed as a program service due to underutilization.

            (5) New employment services have been incorporated for individual employment support, follow along support, small group employment support, and coworker support services.  The purpose of these added services is to promote progressive change through integrative competitive employment to enable persons with developmental disabilities opportunity to advance economically and participate as productive members of society.

            (6) Waiver-funded children's case management was amended to remove the requirement for family support specialist (FSS) certification as a qualified provider for the provision of waiver-funded children's case management. The provider must have education and experience equal to an FSS. Removing the certification requirement is necessary as it allows for a more open qualified provider enrollment process.

            (7) Environmental modifications/adaptive equipment requirement was amended to reflect that a provider's board of directors must no longer approve purchases over $4,000.  This is removed because not all providers have a board of directors.

            (8) Behavioral support services is now a service option for facilities such as licensed adult foster homes, developmental disabilities licensed group homes, assisted living, and transitional living apartments. 

            (9)  Board certified behavior analyst has been replaced with behavioral support services. This change is due to recent changes in ARM 37.34.1422, which allows for other professionals to also approve positive behavior support plans.

 

New Rules II and III

 

New Rules II and III pertain to self-directed services.  Many of the new services approved in the 0208 HCBS Waiver Program allow for self-direction. These proposed new rules are necessary to provide uniform definitions and foundational requirements for self-directed services.

 

ARM 37.34.901

 

ARM 37.34.901 presents the federal authority under Section 1915(c) of the Social Security Act, providing states the option to renew their Medicaid waiver to offer home and community-based services. In addition, the proposed rule amendments establish the discretion of the department to manage the various aspects of the program in conformance with federal authority and as otherwise determined appropriate by the department. This conformance of the program to federal authority is necessary to ensure continuing conformance with the governing federal authority so as to avoid withdrawal of federal approval for the program and to avoid federal recoupment for inappropriate expenditures of federal monies. 

 

ARM 37.34.902

 

The department is proposing to amend ARM 37.34.902, Medicaid Home and Community Services Program:  Generally, in order to update the rule to correspond with current terminology and to remove language that is no longer pertinent.

 

ARM 37.34.906

 

The department is proposing to amend ARM 37.34.906, Medicaid Home and Community Services Program:  Eligibility, in order to update the rule to correspond with current terminology and to remove language that is no longer pertinent. Reference to mental retardation is replaced with intellectual disability in accordance with federal regulation and state statute. Additionally, information previously contained in ARM Title 37, chapter 34, subchapter 2 regarding the eligibility process for the 0208 HCBS Waiver Program has been added in order to provide a more comprehensive rule.

 

ARM 37.34.907

 

The department is proposing to amend ARM 37.34.907, Medicaid Home and Community Services Program: Intensive Services Review Committee. It is necessary because the DDP no longer offers designated intensive services residential settings and therefore the intensive services review committee is no longer maintained. In order to maintain the rule number, the department is proposing to place "selection and entry" in this rule number. Effective July 1, 2013, the department implemented several changes required by CMS. CMS directed that service opportunities could no longer be made available based upon the expected cost of services or the type of services a person may need. In addition, the changes were needed to provide for more equitable selection of persons for available service opportunities. All eligible persons requesting acceptance into the 0208 Waiver Program will be placed on a waiting list. The person will be selected from the wait list by the department for available service opportunities in the 0208 Waiver Program based on longest duration on the wait list. However, a person considered to be in an emergency situation as defined by the department will have priority in selection over those of the longest duration. A further change required by CMS is that any service opportunity that becomes available must be available to the selected person on a statewide basis.

 

ARM 37.34.911

 

The department is proposing to amend ARM 37.34.911, Medicaid Home and Community Services Program: Available Services. This is necessary to update services available as approved by CMS. The department is also amending the rule to reorganize placement of the services in the rules. Due to the extensive nature of amendments required in this rulemaking, the department recognized the opportunity to align the services alphabetically for ease of access and to preserve rule numbers due to the limited resources for rule numbers within this subchapter. The public may still review changes to existing services by referring to the appropriate current rule within the document.

 

ARM 37.34.912

 

The department is proposing to amend ARM 37.34.912, Medicaid Home and Community Services Program: General Provider Requirements. This is necessary to allow for the addition of training requirements, to reflect current department practice and terminology, and changes in federal requirements. 

 

The accreditation in (2) is no longer required and has been removed. Reimbursement information contained in (4) is located in the reimbursement rules located in ARM Title 37, chapter 34, subchapter 30.

 

The department is proposing to adopt and incorporate the Provider Specifications for Services Matrix for the 0208 Waiver Program, dated December 27, 2013 (matrix). The matrix conveys the training, licensing, certification, and educational requirements for each service and service provider option.  Due to the fact that these requirements vary by service as well as by service providers, the department created the matrix to articulate a large quantity of information in one comprehensive document.

 

ARM 37.34.913

 

The department is proposing to amend ARM 37.34.913, Medicaid Home and Community Services Program: Reimbursement. This is necessary in order to revise the title to be consistent with the remainder of the rules.

 

ARM 37.34.917

 

The department is proposing to amend ARM 37.34.917, Medicaid Home and Community Services Program: Individual Plans of Care. This is necessary because the governing rules for the application and implementation of the plan of care for the delivery of developmental disabilities services are now located in Title 37, chapter 34, subchapter 11. In order to preserve the rule number, rather than simply repeal the rule, the department is replacing the information with termination of placement.  Termination of placement, currently located in ARM 37.34.225, is being repealed in MAR Notice No. 37-645.

 

ARM 37.34.918

 

The department is proposing to amend ARM 37.34.918, Medicaid Home and Community Services Program: Informing Beneficiary of Choice. This is necessary to update current terminology and to add requirements to coincide with current practice.

 

ARM 37.34.919

 

The department is proposing to amend ARM 37.34.919, Medicaid Home and Community Services Program: Notice and Fair Hearing. This is necessary to update current terminology and to reference to the fair hearings rules, located in Title 37, chapter 5.

 

           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: 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., November 29, 2013.

 

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. 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.

 

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

 

11. With regard to the requirements of 2-4-111, MCA, the department has determined that the adoption and amendment of the above-referenced rules will not significantly and directly impact small businesses.

 

 

/s/ Cary B. Lund                                           /s/ Richard H. Opper                                   

Cary B. Lund                                               Richard H. Opper, Director

Rule Reviewer                                              Public Health and Human Services

           

Certified to the Secretary of State October 21, 2013.

 

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