BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.87.809 pertaining to targeted case management services for youth with serious emotional disturbance, reimbursement
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On September 22, 2016, at 1:30 p.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rule.
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 the Department of Public Health and Human Services no later than 5:00 p.m. on September 14, 2016, 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 email@example.com.
3. The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:
37.87.809 TARGETED CASE MANAGEMENT SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE, REIMBURSEMENT (1) Targeted case management (TCM) services for youth with SED will be reimbursed on a fee per unit of service basis. For purposes of this rule, a unit of service is
a period of 15 minutes based on a 15-minute unit increment.
(a) A unit of service is a period of 15 minutes as follows:
(i) (a) one unit of service is greater than or equal to 8 minutes and but less than or equal to 23 minutes;
(ii) (b) two units of service are greater than or equal to 24 23 minutes and but less than or equal to 38 minutes;
(iii) (c) three units of service are greater than or equal to 39 38 minutes and but less than or equal to 53 minutes;
(iv) (d) four units of service are greater than or equal to 54 53 minutes and but less than or equal to 68 minutes;
(v) (e) five units of service are greater than or equal to 69 68 minutes and but less than or equal to 83 minutes;
(vi) (f) six units of service are greater than or equal to 84 83 minutes and but less than or equal to 98 minutes;
(vii) (g) seven units of service are greater than or equal to 99 98 minutes and but less than or equal to 113 minutes; and
(viii) (h) eight units of service are greater than or equal to 114 113 minutes and but less than or equal to 128 minutes.
(2) The department will pay providers of targeted case management services for youth with SED the lesser of:
(a) and (b) remain the same.
(3) TCM services may be billed to the department's fiscal agent using a Center for Medicare and Medicaid Systems (CMS) 1500 claim form. The provider must include the youth's DSM-IV diagnosis code on the claim form.
(4) and (5) remain the same, but are renumbered (3) and (4).
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-1-601, 53-1-602, 53-1-603, 53-2-201, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (department) proposes to amend ARM 37.87.809. This administrative rule defines the timed units of service for Targeted Case Management Services for Youth with Serious Emotional Disturbance. Specifically the department proposes the following:
Amending this rule is necessary in order to align the definition of the timed unit with the November 24, 2010 Montana Health Care Programs Notice and with the Centers for Medicare and Medicaid (CMS).
There is no anticipated fiscal impact due to this rulemaking.
5. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail firstname.lastname@example.org, and must be received no later than 5:00 p.m., September 30, 2016.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.
8. An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.
9. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
10. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.
11. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.
The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.
/s/ Brenda K. Elias /s/ Richard H. Opper
Brenda K. Elias, Attorney Richard H. Opper, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State August 22, 2016.