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| Montana Administrative Register Notice 37-1010 | No. 15 08/05/2022 | |
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BEFORE THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES OF THE STATE OF MONTANA
TO: All Concerned Persons
1. On August 30, 2022, at 9:00 a.m., the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider the proposed adoption, amendment, and repeal of the above-stated rules. Interested parties may access the remote conferencing platform in the following ways: (a) Join Zoom Meeting at: https://mt-gov.zoom.us/j/85633901312?pwd=UWhWa0loUDNzdnpVcUZPaExVRktQdz09 Meeting ID: 856 3390 1312, and Password: 043073; or (b) Dial by telephone +1 646 558 8656, Meeting ID: 856 3390 1312, and Password: 043073. Find your local number: https://mt-gov.zoom.us/u/kcfa5N2nLG.
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 August 16, 2022, to advise us of the nature of the accommodation that you need. Please contact Kassie Thompson, 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 STATE APPROVED PROGRAMS, SANCTIONS (1) The department, after written notice to the program, may sanction a program's state approval upon finding that the program: (a) fails to meet any state approval requirements established by this subchapter; (b) fails to meet regulations or licensure standards set forth in ARM Title 37, chapter 106, subchapter 14; (c) has failed to use state or federal funds received under contract with the department or through Montana Medicaid as required, pursuant to state or federal regulations, for the operations of a program or provision of services; (d) has failed to comply with a performance action plan approved by the department; (e) has committed unprofessional conduct pursuant to 37-1-316, MCA; (f) has current orders or sanctions pursuant to 37-1-312, MCA; or (g) has current sanctions pursuant to ARM Title 37, chapter 85, subchapter 5. (2) The department will issue a 90-day restricted state approval to a program that has failed to meet requirements of this rule and has submitted a performance action plan approved by the department. (3) The department will issue a suspension of state approval, for up to one year, to a program that has failed to meet requirements of this rule during a restricted state approval and has submitted a performance action plan approved by the department. (a) Programs approved under ARM 37.27.107 will receive an immediate suspension of state approval if their professional license has been suspended by the licensing board. Suspension will be the same length of time determined by the licensing board or one year, whichever is greater. (4) The department will revoke a program's state approval if the program: (a) has failed to meet requirements of this rule during a suspension of their state approval; (b) has been excluded from participation in a government health care program; or (c) approved under ARM 37.27.107, has had its professional license revoked by the licensing board. (5) A restriction or suspension of state approval may only be issued one time within a two-year period. (6) Any program whose state approval has been revoked under the provisions of this subchapter may not submit another application for state approval within one year from the date of revocation and all deficiencies identified in the performance action plan have been corrected. (7) Any program whose state approval has been restricted, suspended, or revoked has the right to request a hearing as set forth in ARM Title 37, chapter 5, subchapter 3.
AUTH: 53-24-204, 53-24-207, 53-24-208, MCA IMP: 53-24-208, MCA
NEW RULE II INDIVIDUAL OUTPATIENT TREATMENT AND PREVENTION PROVIDERS, CONFIDENTIALITY (1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a written client confidentiality policy pursuant to 42 CFR Part 2. (2) The confidentiality policy must be reviewed with the client at the time of admission or as soon thereafter as the client is capable of rational communication. (3) Policy requirements must include activities to: (a) inform clients that federal law and regulations protect the confidentiality of alcohol and drug abuse client records; and (b) provide clients with a summary in writing of the federal law and regulations. (4) The written summary required in (3)(b) must include: (a) a general description of limited circumstances under which a SUD program may acknowledge a client is present at a facility or disclose information identifying a client as an alcohol or drug abuser; (b) a statement that violation of the federal law and regulations by a SUD program is a crime and suspected violations may be reported to appropriate authorities in accordance with these regulations; (c) a statement that information related to a client's commission of a crime on the premises of the SUD program or against staff members of the SUD program is not protected; (d) a statement that reports of suspected child abuse or neglect made under state law to appropriate state or local authorities are not protected; and (e) a citation to the federal law and regulations. (5) Client consent must be obtained for each release of information to any other person or entity if required under 42 CFR Part 2. The consent for release of information must have specific information pursuant to 42 CFR Part 2.
AUTH: 53-24-204, 53-24-207, MCA IMP: 53-24-208, MCA
NEW RULE III INDIVIDUAL OUTPATIENT TREATMENT AND PREVENTION PROVIDERS, COMMUNICABLE DISEASE CONTROL (1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a policy for communicable disease control. (2) The communicable disease policy must be reviewed annually and include: (a) procedures to identify high risk individuals; (b) specific procedures to address tuberculosis (TB), Hepatitis A, Hepatitis C, sexually transmitted infections (STI), and human immunodeficiency virus (HIV); and (c) the identification of methods used to protect, contain, or minimize the risk to clients and staff members. (3) The program is responsible for the direction, provision, and quality of infection prevention and control services. (4) Programs must implement TB protocols for all staff members and clients based upon an annual TB Risk assessment as set forth by the Montana Tuberculosis Prevention and Control Program pursuant to ARM Title 37, chapter 114, subchapter 10. Risk assessment and TB manuals are found at https://dphhs.mt.gov/publichealth/cdepi/diseases/Tuberculosis/.
AUTH: 53-24-204, 53-24-207, MCA IMP: 53-24-208, MCA
NEW RULE IV INDIVIDUAL OUTPATIENT TREATMENT AND PREVENTION PROVIDERS, ABUSE OR NEGLECT REQUIREMENTS (1) Programs approved under ARM 37.27.105 and 37.27.107 providing treatment (including early intervention) must have a policy that: (a) clearly defines child abuse and neglect as defined in 41-3-102, MCA; (b) clearly defines abuse, neglect, and exploitation of an older person or a person with a developmental disability as defined in 52-3-803 MCA; (c) outlines the provider's responsibility to report all known or suspected incidents of abuse, neglect, or exploitation of any client within 24 hours; and (d) addresses handling of suspected or validated incidents of abuse, neglect, or exploitation. (2) Any provider who knows or has reasonable cause to suspect an incident of child abuse or neglect has occurred must make a report within 24 hours of the incident to the state child abuse hotline (866) 820-5437 as required in 41-3-201, MCA. (3) Any provider who knows or has reasonable cause to suspect an incident of abuse, neglect, or exploitation of a vulnerable adult has occurred must make a report within 24 hours of the incident to Adult Protective Services or other bodies as required in 52-3-811, MCA. (4) In addition to reporting requirements in (2) and (3), the provider must also make a report to the department in writing within 24 hours of any allegations of client abuse, neglect, or exploitation within the program. (5) The program must document, in writing, that the proper authorities have been contacted and the abuse, neglect, or exploitation has been reported. (6) The provider must fully cooperate with any investigation conducted because of the report.
AUTH: 53-24-204, MCA IMP: 41-3-102, 41-3-201, 52-3-803, 52-3-811, 53-24-208, MCA
NEW RULE V NON-MEDICAID MENTAL HEALTH SERVICES FOR ADULTS: REQUIREMENTS (1) In addition to requirements contained in rule, the department has developed and published the Behavioral Health and Developmental Disabilities Division Non-Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health, dated October 1, 2022, which provides information and policies pertaining to state-funded behavioral health services and substance use disorder services and implements requirements for utilization management and services. The department adopts and incorporates by reference the manual as part of this rule. A copy of the manual may be obtained from the department by a request in writing to the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 100 N. Park, Ste. 300, P.O. Box 202905, Helena, MT 59620-2905 or at https://dphhs.mt.gov/amdd/AMDDMedicaidServicesProviderManual.
AUTH: 53-2-201, 53-21-1405, MCA IMP: 53-21-1401, 53-21-1402, 53-21-1403, 53-21-1404, 53-21-1405, MCA
NEW RULE VI CONFIDENTIALITY (1) A substance use disorder facility (SUDF) must have a written client confidentiality policy pursuant to 42 CFR Part 2. (2) The confidentiality policy must be reviewed with the client at the time of admission or as soon thereafter as the client is capable of rational communication. (3) Policy requirements must include activities to: (a) inform clients that federal law and regulations protect the confidentiality of alcohol and drug abuse client records; and (b) provide clients with a summary in writing of the federal law and regulations. (4) The written summary required in (3)(b) must include: (a) a general description of limited circumstances under which a SUDF may acknowledge a client is present at a facility or disclose information identifying a client as an alcohol or drug abuser; (b) a statement that violation of the federal law and regulations by a SUDF is a crime and suspected violations may be reported to appropriate authorities in accordance with these regulations; (c) a statement that information related to a client's commission of a crime on the premises of the SUDF or against staff members of the SUDF is not protected; (d) a statement that reports of suspected child abuse or neglect made under state law to appropriate state or local authorities are not protected; and (e) a citation to the federal law and regulations. (5) Client consent must be obtained for each release of information to any other person or entity if required under 42 CFR Part 2. The consent for release of information must have specific information pursuant to 42 CFR Part 2.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE VII REPORTING REQUIREMENTS (1) All serious incidents, as defined in ARM 37.106.1413, must be reported to the Department of Public Health and Human Services, Office of Inspector General, Licensure Bureau, within 24 hours. The report must be in writing and must include: (a) the date and time of the incident; (b) all clients and staff members involved; and (c) a description of the incident and the circumstances surrounding it. (2) A copy of the incident report must be maintained at the SUDF. (3) A SUDF must report a change in administrator prior to the effective date of change. (4) Changes in the facility location, use, or number of facility beds cannot be made without written notice to, and written approval received from, the department.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE VIII ABUSE OR NEGLECT REQUIREMENTS (1) A substance use disorder facility (SUDF) must require each staff member to read and sign a statement that: (a) clearly defines child abuse and neglect as defined in 41-3-102, MCA; (b) clearly defines abuse, neglect, and exploitation of an older person or a person with a developmental disability as defined in 52-3-803 MCA; and (c) outlines the individual's responsibility to report all known or suspected incidents of abuse, neglect, or exploitation of any client within 24 hours. (2) Any SUDF staff member who knows or has reasonable cause to suspect an incident of child abuse or neglect has occurred must make a report within 24 hours of the incident to the SUDF administrator, or a person designated by the SUDF administrator, and to the state child abuse hotline (866) 820-5437 as required in 41-3-201, MCA. (3) Any SUDF staff member who knows or has reasonable cause to suspect an incident of abuse, neglect, or exploitation of a vulnerable adult has occurred must make a report within 24 hours of the incident to the SUDF administrator, or a person designated by the SUDF administrator and to Adult Protective Services or other bodies as required in 52-3-811, MCA. (4) In addition to reporting requirements in (2) and (3), the SUDF must also make a report to the Office of Inspector General, Licensing Bureau in writing within 24 hours of any allegations of client abuse, neglect, or exploitation within the SUDF. (5) The SUDF must document, in writing, that the proper authorities have been contacted and the abuse, neglect, or exploitation has been reported. (6) The SUDF must fully cooperate with any investigation conducted because of the report. (7) The SUDF must have written policies for handling suspected incidents of abuse, neglect, or exploitation, including: (a) procedures for ensuring staff members suspected of abuse, neglect, or exploitation do not continue to provide direct care until an investigation is completed; (b) development of a safety plan, approved by the department, which protects the client and staff member until the investigation is complete; and (c) procedures for taking appropriate disciplinary measures against any staff member involved in an incident of client abuse, neglect, or exploitation upon validation of the allegation, including: (i) termination of employment; (ii) retraining of the staff member; or (iii) any other appropriate action by the SUDF geared toward the prevention of future incidents of client abuse, neglect, or exploitation.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE IX STAFF MEMBER TRAINING (1) A substance use disorder facility (SUDF) must have written policies, procedures, and initial and ongoing training curriculum to meet minimum requirements in this rule. (2) All staff members supervising, or providing, direct contact with clients must complete orientation training prior to supervising, or providing, direct care consisting of the following requirements: (a) an overview of the SUDF policies, procedures, organization, and services; (b) mandatory adult and child abuse, neglect, and exploitation reporting laws; (c) fire safety, including emergency evacuation routes; (d) confidentiality; (e) suicide ideation and referral procedures; (f) emergency medical procedures; (g) documentation requirements; (h) client rights and client grievance process; (i) blood and air-borne pathogens; (j) crisis prevention and de-escalation techniques; and (k) upon completion of the orientation, the SUDF must complete a competency assessment for each staff member's ability to apply knowledge of material learned. Assessment results must be documented in each staff member's personnel file. (3) Staff members supervising or providing direct care to clients must complete the following certification training within six months of hire: (a) first aid; (b) cardio-pulmonary resuscitation (CPR) that includes direct instruction of the practical and demonstrated applications of CPR methods as taught by an instructor from an accredited entity; and (c) physical restraint training for adolescent programs utilizing physical restraint. (4) Staff members must maintain and update trainings and certifications in (3) as required. (5) Staff members providing direct care to clients must not work unsupervised with clients without completing requirements in (3). (6) The SUDF must ensure 20 hours of annual training is provided for staff members providing direct care to improve proficiency in their knowledge and skills for the level of care provided. (7) All training must be documented and kept on file for each staff member. (8) All staff members working with adolescents must have training in adolescent development.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE X ADOLESCENT FACILITIES (1) In addition to policies required throughout this rule, a SUDF licensed to serve adolescents must have written policies and procedures that address: (a) limiting admission to adolescents 17 years of age or younger or adolescents 18, 19, and 20 years of age if a client is enrolled in certified secondary school, and the assessment completed by a LAC or mental health professional with substance use in the scope of their license determines their appropriateness for adolescent treatment; (b) age-appropriate treatment; (c) separation of adolescents from adults in all characteristics of the treatment process; (d) separation of adolescents from adults in all non-treatment aspects including eating, sleeping, bathing, and recreation activities; and (e) staffing patterns to ensure staff members of the same sex as clients are present at all times. (2) The SUDF must maintain the minimum client to direct care staff ratios: (a) from 7:00 a.m. to 11:00 p.m.: eight adolescents to one direct care staff; (b) from 11:00 p.m. to 7:00 a.m.: 12 adolescents to one direct care staff; and (c) programs must have at least one awake night staff in each building or unit housing adolescents. (3) The SUDF must: (a) allow communication between the adolescent and the adolescent's parent or legal guardian a minimum of one time per week and facilitate the communication when clinically appropriate; (b) provide family therapy as indicated in the individualized treatment plan or document reasons why family therapy may not be provided; (c) notify the parent or legal guardian within two hours of any serious incident as defined in ARM 37.106.1413 involving the adolescent; (d) discharge the adolescent to the care of the adolescent's parent or legal guardian. For emergency discharge and when the parent or legal guardian is not available, the program must contact the appropriate authority; and (e) only admit adolescents with the written consent of the adolescent's parent or legal guardian. (4) The SUDF must have protocols for evaluating the treatment implications and safety concerns for determining whether being placed in a room with another specific adolescent is appropriate. (5) In no circumstances should adolescents of more than three years age difference be placed in the same room. (6) Adolescent facilities utilizing physical restraints must have written policies and procedures governing the appropriate use of crisis intervention and physical restraint strategies including: (a) training for all staff in crisis intervention, de-escalation, and physical restraint by a state approved or nationally recognized program; (b) that crisis prevention and de-escalation techniques are the preferred methods and must be used first to manage behavior; (c) physical restraint must only be used to safely control an adolescent until the adolescent can regain control of the adolescent's own behavior; (d) prohibit the use of physical restraint if an adolescent has a documented physical condition that would contradict its use unless a health care professional has previously and specifically authorized its use in writing. Documentation must be maintained in the adolescent's client record; and (e) prohibiting the use of prone physical restraints. (7) Physical restraint must only be used in the following circumstances: (a) when the adolescent has failed to respond to de-escalation techniques, and it is necessary to prevent harm to the adolescent or others; or (b) when an adolescent's behavior puts themselves or others at substantial risk of harm and the adolescent must be forcibly moved. (8) Physical restraint must be used only by staff members who are specifically trained and certified in physical restraint techniques. (9) The SUDF must document the following for each physical restraint: (a) adolescent's behavior which required the physical restraint; (b) specific attempts to de-escalate the situation before using physical restraint; (c) length of time the physical restraint was applied, including documentation of the time the restraint began and ended; (d) identity of specific staff member(s) involved in administering the physical restraint; (e) type of physical restraint used; (f) any injuries to the adolescent resulting from the physical restraint; and (g) a face-to-face debriefing completed within 24 hours of the restraint, including: (i) the staff member(s) and adolescent involved in the physical restraint; (ii) providing the adolescent and staff involved the opportunity to discuss the circumstances resulting in the use of the restraint; and (iii) strategies that could be used by the staff, the adolescent, and/or others that could prevent the future use of restraint. (10) The SUDF must provide access to an educational program appropriate to the needs of the youth and comply with state school attendance laws, as provided in Title 20, chapter 5, MCA. (11) Group counseling sessions must be provided by a licensed addiction counselor or mental health professional and must not exceed eight adolescents to one adult staff member. (12) All staff members working directly with adolescents must be at least 21 years of age. (13) The SUDF must not employ any staff member that has a substantiation of child abuse or neglect.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XI MEDICATION STORAGE AND ADMINISTRATION (1) A substance use disorder facility (SUDF) must have a written policy addressing requirements for the storage, administration, and disposal of prescription, nonprescription, and over-the-counter medication. (a) Policies must include protocols for daily monitoring, counting of stored narcotics and other medication that has the potential for abuse. (2) All medication must be: (a) kept in a locked non-portable container or in a locked medical room; and (b) stored in its original container with the original prescription label. (3) For assistance with self-administration of medications outside of the facility, all medications must be in the possession of a staff member trained to assist with the self-administration of medications. (4) Staff members assisting with medication self-administration must be trained to assist in proper medication procedures. (a) Upon completion of the training, the SUDF must test each staff member's knowledge and observe staff demonstrating the skills of such materials. Test results must be documented in each staff member's personnel file. (5) All medications must be ordered by a licensed health care professional working within the scope of his/her practice. All prescription orders must contain the dosage to be given. (6) A written record of all medications self-administered by a client must be maintained. The record must include: (a) client's name; (b) name and dosage of medication; (c) date and time the medication was taken or was refused by the client; (d) name of the staff member who assisted in the self-administration of the medication; and (e) documentation of any medication error, the results of such error, any effects observed, and any action taken to address such error. (7) A written record of all medications administered by a licensed health care professional must be maintained and meet documentation requirements for medication administration under the professional's individual license. (8) Prescribed medication must not be stopped or changed in dosage or administration without first consulting a licensed health care professional, as defined in ARM 37.106.2805. Consultation results must be recorded in the client's record. The licensed health care professional must document, in writing, any changes to medication. This documentation must be kept as part of the client's record. (9) Placing case workers, parents, or custodial guardians must be notified of all medications prescribed to adolescents, including medication changes. (10) All unused and expired medication must be properly disposed of and documented in the client's record. (11) A SUDF cannot require clients to discontinue the use of any medication prescribed by a licensed health care professional for admission.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XII PETS (1) When pets are kept on the premises, the SUDF must write and adhere to procedures for their care and maintenance. (2) When animals are kept on the premises, the following conditions must be met: (a) proof of current vaccinations must be kept on file at the facility; (b) pets not confined in enclosures must be under control; (c) pets must not present a danger to clients, staff members, or visitors; (d) pets are not permitted in food preparation, storage, or dining areas during meal preparation time or during meal service or in an area where their presence would create a significant health or safety risk to others; (e) staff members and clients must wash their hands after handling animal food and animal waste; (f) pets must be kept clean and disease-free; (g) pet enclosures, bedding, equipment, and supplies are kept clean and in good repair; and (h) protocols are in place to address how reasonable accommodations will be made for clients and staff members with allergies to animals housed in the facility or who may visit the facility as part of a therapeutic treatment program. (3) The SUDF will not keep or bring in ferrets, turtles, iguanas, lizards, or other reptiles, psittacine birds (birds of the parrot family), or any wild or dangerous animals. (4) This rule does not apply to service animals.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XIII FOOD SERVICE (1) An inpatient or residential SUDF must establish policies and procedures for standards relative to safe food handling, storage, preparation, and serving, to prevent food spoilage and the transmission of infectious disease. The policies and procedures must include provisions that: (a) all food must be from an approved source and shall be transported, stored, covered, prepared, and served in a sanitary manner to prevent contamination; (b) food must be free from adulteration or other contamination and must be safe for human consumption; (c) food removed from the original container must be dated, labeled, and sealed; (c) milk and other dairy products must be pasteurized; (d) use of home canned foods other than jams, jellies, and fruits is prohibited; (e) use of thermometers is required to check food temperatures; (f) cold storage of potentially hazardous food must be at 41°F or below; (g) frozen food must be kept frozen; (h) hot storage of potentially hazardous food must be 135°F or above; (i) each type of food must be stored and arranged so that cross-contamination of one type with another is prevented; (j) raw fruits and vegetable must be thoroughly washed in potable water to remove soil and other contaminants before being cut, combined with other ingredients, cooked, served, or offered for human consumption in ready-to-eat form. Fruits and vegetables may be washed by using chemicals approved by the U.S. Environmental Protection Agency; (k) food packages must be in good condition and protect their contents, so that the food is not exposed to adulteration or potential contaminants; and (l) packaged food may not be stored in direct contact with water or undrained ice if the food package could allow water entry. (2) The facility must have conveniently located hand washing facilities, supplied with hand soap, disposable towels kept clean in a dispenser, and a cleanable trash can. (3) Staff handling or preparing food shall thoroughly wash hands, wrists, and exposed arms with soap and warm running water for at least 20 seconds: (a) before touching anything used to prepare food; (b) before touching food that will not be cooked; (c) after touching raw meat, fish, or poultry; (d) after cleaning, handling dirty dishes, removing garbage, or storing supplies; (e) after using the toilet facilities; (f) after eating or drinking; (g) after touching the face, hair, or skin; (h) after blowing the nose, coughing, or sneezing; and (i) after touching any soiled object. (4) After handwashing, hands must be dried, and faucets turned off with a clean paper towel. (5) If used, chemical hand sanitizers must be followed by thorough hand rinsing before contact with food. (6) General health and safety requirements include the following: (a) use of clean cutting boards, knives, can openers, and other equipment and utensils for each type of food preparation to prevent cross-contamination; (b) a person with symptoms of a communicable disease that can be transmitted to foods or who is a carrier of such a disease may not work with food, clean equipment, or clean utensils; (c) kitchenware, tableware, and food contact surfaces must be washed, rinsed, and completely dried after each use; and (d) sinks used for food preparation must be cleaned before beginning the preparation of the food. (7) A domestic style dishwasher may be used only if it is equipped with a heating element and the following conditions are met: (a) the dishwasher must have water at a temperature of at least 165°F when it enters the machine, if it uses hot water for sanitization; and (b) at least a two-compartment sink must be available as a backup in the event the dishwasher becomes inoperable. (8) If a two-compartment sink is used, all dishware, utensils, and food service equipment must be thoroughly cleaned in the first sink compartment with a hot detergent solution that is kept clean and at a concentration indicated on the manufacturer's label and sanitized in the second compartment by immersion in any chemical sanitizing agent. (9) Food must be served in amounts and variety sufficient to meet the nutritional needs of each client. (10) At least three meals must be offered daily and at regular times, with not more than a 12-hour span between an evening meal and breakfast unless a nutritious snack is available in the evening, then up to 14 hours may lapse between a substantial evening meal and breakfast. (11) Records of menus as served must be on file for three months after the date of service for review by the department. (12) The SUDF must provide for therapeutic or special diets ordered by the client's licensed health care professional. (13) A minimum of a one-week supply of non-perishable foods and a two-day supply of perishable foods must be available on the premises.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XIV ASAM 3.5 CLINICALLY MANAGED HIGH INTENSITY RESIDENTIAL (ADULT)/MEDIUM INTENSITY RESIDENTIAL (ADOLESCENT) SUBSTANCE USE DISORDER FACILITY REQUIREMENTS (1) To be licensed to provide ASAM 3.5 services as outlined in the ASAM Criteria, a SUDF must meet the following staffing requirements: (a) clinical director; (b) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to clients with substance use and mental disorders as described by this chapter and in accordance with the clients' individualized treatment plans; (c) a licensed addiction counselor or mental health professional must be on-site or on call 24 hours a day, seven days a week; (d) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans; and (e) rehabilitation aides in sufficient number to provide on-site 24 hours a day, seven days a week staffing to assure the safety of clients and to provide direct care services and supervision of clients. (2) Daily clinical and other scheduled skilled treatment services must be provided on-site a minimum of seven hours (four hours for adolescent programs) per day. (3) The SUDF must provide recreational activities daily. (4) The SUDF must coordinate transfers with other licensed health care facilities or correctional facilities. (5) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XV ASAM 3.3 CLINICALLY MANAGED POPULATION-SPECIFIC HIGH INTENSITY RESIDENTIAL (ADULT ONLY) SUBSTANCE USE DISORDER FACILITY (1) To be licensed to provide ASAM 3.3 services as outlined in the ASAM Criteria, a SUDF must meet the following staffing requirements: (a) clinical director; (b) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to clients with substance use and mental disorders as described by this chapter and in accordance with the clients' individualized treatment plans; (c) a licensed addiction counselor or mental health professional must be on-site or on call 24 hours a day, seven days a week; (d) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans; and (e) rehabilitation aides in sufficient number to provide on-site 24 hours a day, seven days a week staffing to assure the safety of clients and to provide direct care services and supervision of clients. (2) Daily scheduled skilled treatment services must be provided on-site. Services must be adapted to the client's developmental stage and level of comprehension in accordance with the client's individualized treatment plan. (3) Individuals with significant cognitive deficits require specialized services to be offered at a slower, repetitive pace. (4) The SUDF must provide recreational activities daily. (5) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XVI ASAM 3.1 CLINICALLY MANAGED LOW INTENSITY RESIDENTIAL (ADULT OR ADOLESCENT) SUBSTANCE USE DISORDER FACILITY (1) To be licensed to provide ASAM 3.1 services as outlined in the ASAM Criteria, a SUDF must meet the following staffing requirements: (a) clinical director; (b) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to clients with substance use disorders as described by this chapter and in accordance with the clients' individualized treatment plans; (c) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans; and (d) rehabilitation aides in sufficient numbers to provide on-site 24 hours a day, seven days a week staffing to assure the safety of clients and to provide direct care services and appropriate supervision of clients. (2) Weekly scheduled skilled treatment services must be provided on-site a minimum of five hours per week. (3) Life skills training provided in a one on one or classroom setting, as part of the daily living regiment, must utilize an evidence-based practice addressing independent living skills, vocational skills, and parenting skills. (4) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XVII ASAM 2.5 PARTIAL HOSPITALIZATION SUBSTANCE USE DISORDER FACILITY (1) To be licensed to provide ASAM 2.5 services as outlined in the ASAM Criteria, a SUDF must meet the following staffing requirements: (a) clinical director; (b) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to clients with substance use disorders as described by this chapter and in accordance with the clients' individualized treatment plans; (c) care managers in sufficient numbers to provide services to clients required by this chapter and in accordance with the clients' individualized treatment plans; and (d) rehabilitation aides in sufficient number to provide direct care services and supervision of clients. (2) The SUDF must have direct access by consultation or referral to medical and psychiatric services within eight hours by telephone or 48 hours in person. (3) Weekly scheduled skilled treatment services must be provided by an interdisciplinary team of appropriately licensed and trained staff a minimum of 20 hours per week. (4) If treatment services cannot be provided a minimum of 20 hours in a given week due to unforeseen issues such as illness, medical appointments, or other similar circumstances, the program must document the following: (a) reason for not meeting the minimum hourly requirements; and (b) attempts to follow-up and reschedule client treatment services. (5) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care and supportive housing services must be available through direct affiliation or referral processes.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XVIII OUTPATIENT SUBSTANCE USE DISORDER FACILITY (1) To be licensed to provide SUD services in an outpatient setting, a SUDF must meet the following staffing requirements: (a) clinical director; (b) licensed addiction counselors or mental health professionals in sufficient numbers to provide counseling and therapy services to patients with substance use disorders as described by this chapter and in accordance with the patients' individualized treatment plans; and (c) care managers in sufficient numbers to provide services to patients required by this chapter and in accordance with the patients' individualized treatment plans. (2) Skilled treatment services must be provided by an interdisciplinary team of appropriately licensed, certified, and/or trained staff. (3) An outpatient substance use disorder facility must provide crisis telephone services and comply with the following requirements: (a) ensure crisis telephone services are available 24 hours a day, seven days a week; (b) answering services or other individuals may be used to transfer calls to individuals trained to respond to crisis calls. (4) The facility must have written policies and procedures outlining crisis telephone services that include: (a) training requirements for individuals responding to crisis calls; (b) ensuring a licensed addition counselor or mental health professional provides consultation and backup, as indicated, for unlicensed individuals responding to crisis calls; and (c) utilization of community resources. (5) The facility must maintain documentation for each crisis call that includes: (a) the date and time of the call; (b) the staff involved; (c) identifying data, if possible; (d) the nature of the emergency, including a screening of safety and risk, strengths and resources, and medical concerns related to the crisis; and (e) the result of the intervention. (6) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care and supportive housing services must be available through direct affiliation or referral processes.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XIX COMMUNICABLE DISEASE CONTROL (1) The SUDF must develop and implement an infection prevention and control program and review the program annually. (2) The SUDF must have written policies and procedures regarding infection prevention and control which include: (a) procedures to identify high risk individuals; (b) specific procedures to address tuberculosis (TB), Hepatitis A, Hepatitis C, sexually transmitted infections (STI), and human immunodeficiency virus (HIV); and (c) the identification of methods used to protect, contain, or minimize the risk to clients, staff members, and visitors. (3) The administrator or designated person is responsible for the direction, provision, and quality of infection prevention and control services. (4) Facilities must implement TB protocols for all staff members and clients based upon an annual TB Risk assessment as set forth by the Montana Tuberculosis Prevention and Control Program pursuant to ARM Title 37, chapter 114, subchapter 10. Risk assessment and TB manuals are found at https://dphhs.mt.gov/publichealth/cdepi/diseases/Tuberculosis/.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
NEW RULE XX CARE MANAGEMENT (1) In addition to the requirements established in this subchapter, each SUDF must provide care management services and comply with the requirements established in this rule. (2) A care manager must have a bachelor's degree in a human services field, a combination of education and experience, or a minimum of two years of experience serving individuals with behavioral health issues. (3) Care management services must be provided by staff whose primary duty is the provision of care management services. (4) The SUDF must develop written policies and procedures addressing the independence of the care manager and care management program. At a minimum, the policies and procedures must address: (a) the care manager's role in conflicts between the client and the SUDF or other agencies; (b) the ability of the care manager to freely advocate for services from the SUDF or other agencies on behalf of the client; (c) the relationship between the licensed addiction counselor or mental health professional and the care manager; (d) the obligation to report information to the SUDF staff that the client has requested to be kept confidential; and (e) the ability of the targeted care manager to contact an advocacy organization if the care manager believes the SUDF is unresponsive to the needs of the client.
AUTH: 50-5-103, MCA IMP: 50-5-103, MCA
4. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.27.101 STATE APPROVED PROGRAMS, PURPOSE (1) The purpose of the rules in this subchapter is to establish standards for the approval of programs providing prevention, treatment, rehabilitative, and recovery services to individuals with substance use disorders and substance related issues, as provided in Title 53, chapter 24, part 2, MCA. (2) Each public or private substance use disorder program providing services and receiving alcohol earmarked revenue funds under 53-24-108, MCA, shall be subject to approval by the department. The department will issue approval for the following substance use disorder (SUD) levels of care and specialty services, outlined in the American Society of Addiction Medicine (ASAM) Criteria and Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Manual: (a) ASAM 3.7 Medically Monitored Intensive Inpatient Services; (b) ASAM 3.7-WM Medically Monitored Withdrawal Management Services; (c) ASAM 3.5 Clinically Managed High-Intensity (adult) and Medium Intensity (adolescent) Residential Services; (d) ASAM 3.3 Clinically Managed Population-Specific High Intensity (adult only) Residential Services; (e) ASAM 3.2-WM Clinically Managed Residential Withdrawal Management Services; (f) ASAM 3.1 Clinically Managed Low Intensity (adult or adolescent) Residential Services; (g) ASAM 2.5 Partial Hospitalization Services; (h) ASAM 2.1 Intensive Outpatient Services; (i) ASAM 1.0 Outpatient Services; (j) ASAM 0.5 Early Intervention; (k) SUD Prevention; (l) SUD Certified Behavioral Health Peer Support Services; and (m) SUD Targeted Case Management.
AUTH: 53-24-207, MCA IMP: 53-24-207, MCA
37.27.102 DEFINITIONS In addition to the terms defined in 53-24-103, MCA: (1) (2) "BHDD Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health adopted and incorporated in ARM 37.27.902. The manual can be found at: https://dphhs.mt.gov/amdd/AMDDMedicaidServicesProviderManual. (3) "BHDD Non-Medicaid Manual" means the Behavioral Health and Developmental Disabilities (BHDD) Division Non-Medicaid Services Provider Manual for Substance Use Disorder adopted and incorporated in ARM 37.27.902. The manual can be found at: https://dphhs.mt.gov/amdd/AMDDNonMedicaidServicesProviderManual. (5) "Continuing care plan" means a discharge or recovery management plan as described in the BHDD Medicaid Manual.
(7) "Individualized treatment plan" means a plan of care developed in collaboration with the patient, as described in the BHDD Medicaid Manual. (8) "Licensed addiction counselor (LAC)" means an individual licensed under requirements pursuant to Title 37, chapter 35 MCA, and ARM Title 24, chapter 219, subchapter 50, to provide addiction counseling. References in this subchapter to a LAC do not include an addiction counselor licensure candidate registered pursuant to Title 37, chapter 35, part 2, MCA.
(10) "Progress note" is a written record of a treatment session or service contact as defined in the BHDD Medicaid Manual. (11) "Provisional approval" means a status of state approval granted to chemical dependency treatment programs which are requesting approval for the first time and which have not attained substantial compliance specified in these rules.
(15) "Substance use disorder (SUD)" means chemical dependency, as defined in 53-24-103, MCA.
AUTH: 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA IMP: 53-24-204, 53-24-208, 53-24-209, 53-24-215, MCA
37.27.105 STATE APPROVED PROGRAMS, PREVENTION PROVIDERS, REQUIREMENTS (1) through (3) remain the same. (4) If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Provisional approval is granted to provide time to comply with standards. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely. (5) through (8) remain the same. (9) Approved providers must follow the American Society of Addiction Medicine (ASAM) Criteria in the provision of early intervention services and adhere to requirements outlined in the
AUTH: 53-2-201, 53-24-204, MCA IMP: 53-24-204, 53-24-207, MCA
37.27.106 (2)
(3) (a) (b)
(5) The department shall issue a final approval or deny the application and shall send written notification of full approval or denial to the applicant. (6) The department will reimburse a state approved facility for SUD facility-based services, as outlined in the BHDD Medicaid Manual, using appropriate Common Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes on applicable department fee schedules. (7) (8) (9)
AUTH: 53-24-208, 53-24-204, MCA IMP: 53-24-208, MCA
37.27.107 STATE APPROVED PROGRAMS, INDIVIDUAL OUTPATIENT TREATMENT PROVIDERS (1) In order to be reimbursed for outpatient services, an individual outpatient treatment provider must be state approved and be a licensed addiction counselor. (2) In order to become state approved, the (3) remains the same. (4) If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Provisional approval is granted to provide time to comply with standards. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely. (5) through (8) remain the same. (9) Approved providers must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the
AUTH: 53-2-201, 53-24-204, MCA IMP: 53-24-204, 53-24-207, MCA
37.27.115 ALL STATE APPROVED PROGRAMS – ACCEPTANCE OF PERSONS INTO THE TREATMENT PROGRAM (1) remains the same. (2) The program shall admit and care for only those persons for whom
(4) The program shall make appropriate referrals when the client needs services not offered by the program. Referrals must be documented in the client record. (5) The program shall ensure that clients receiving prescribed medication(s), including medication for opioid use disorder, are not required to discontinue the medication as a condition for receiving services. Access to, and coordination with, qualified medical providers must be made available on-site or through referral.
AUTH: 53-24-209, MCA IMP: 53-24-209, MCA
37.27.116 (a) (b) (c) receive treatment in the least restrictive environment, consistent with law, in a manner sensitive to individual needs and which promotes dignity and self-respect;
(f) (g) (h) (i) have grievances considered in a fair and timely manner, with respect to infringements of rights described in this rule; (j) be given a 30-day notice in the event of program closure or discontinuation of treatment services; (k) be provided with a referral to similar treatment services, if available; and (l) be advised how to access records to which the client is entitled. (2) The program must inform each client and his or her representative, in an understandable manner, of the rights policy, treatment methods, and rules applicable to the client, at the time of admission or as soon thereafter as the client is capable of rational communication. (3) The client and staff member reviewing the policy must sign a statement acknowledging the review. The statement must be maintained in the client's record. (4) The program must post a copy of client rights in a conspicuous place in the facility, accessible to clients and staff members.
AUTH: 53-24-105, 53-24-305, MCA IMP: 53-24-305, MCA
37.27.120 ALL STATE APPROVED PROGRAMS – ORGANIZATION AND MANAGEMENT (1) The
(i) admission criteria/intake process; (ii) assessments; (iii) treatment planning; (iv) documentation of implementation of treatment services; (v) discharge and continuing care planning; and (vi) indications of treatment outcomes. (c) The program will monitor the following treatment outcomes: (i) demographics; (ii) no shows; (iii) wait times; (iv) abstinence and reduction of the use of substances; (v) involvement with the criminal justice system; (vi) stable employment, school, or training; (vii) housing stability; (viii) retention in services; (ix) perception of care; (x) social connectedness; and (xi) use of evidence-based practices.
(i) If a state approved chemical dependency program is receiving public funds through a contract, grant, or written agreement with federal, state, county, or city agencies, records must be retained five years beyond the termination date of said contract, grant, or written agreement. Records shall be retained beyond the five year period if an audit is in process or if any audit findings, (ii) If a state approved program is not receiving public funds (federal, state, county, or city), records must be retained five years beyond the fiscal year end (June 30th) in which that client was most recently discharged from that program. Records shall be retained beyond the five year period if an audit is in process or if any audit findings,
(i) Client records and documentation adhere to requirements described in the BHDD Medicaid Manual and ARM 37.85.414. (j) Programs participate in quarterly updates with the department to ensure contact information, organizational chart, locations, hours of operation, and services provided are up to date for the public to obtain access to care.
AUTH: 53-24-204, 53-24-207, 53-24-208, MCA IMP: 53-24-208, 53-24-209, 53-24-306, MCA
37.27.902 SUBSTANCE USE DISORDER SERVICES: AUTHORIZATION REQUIREMENTS (1) remains the same. (2) In addition to the requirements contained in rule, the department has developed and published the (3) In addition to the requirements contained in rule, the department has developed and published the
AUTH: 53-6-113, 53-24-204, 53-24-208, 53-24-209, MCA IMP: 53-6-101, 53-24-204, 53-24-208, 53-24-209, MCA
37.88.101 MEDICAID MENTAL HEALTH SERVICES FOR ADULTS, AUTHORIZATION REQUIREMENTS (1) remains the same. (2) In addition to the requirements contained in rule, the department has developed and published the (3) Medicaid reimbursement for mental health services will be the lowest of: (a) remains the same. (b) the rate established in the department′s fee schedule. Reimbursement fees are as provided in ARM 37.85.105 (4) The department may review the medical necessity of services or items at any time either before or after payment in accordance with the provisions of ARM 37.85.410. If the department determines that services or items were not medically necessary or otherwise not in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements. (5) remains the same.
IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
37.106.1411 PURPOSE (1) This subchapter establishes the licensing requirements for
(a) (b) (c) (d) (e) ASAM 3.2-WM Clinically Managed Residential Withdrawal Management Services; (f) ASAM 3.1 Clinically Managed Low Intensity (adult or adolescent) Residential Services; (g) ASAM 2.5 Partial Hospitalization Services; and (h) Outpatient Substance Use Disorder Facility.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
37.106.1413 DEFINITIONS In addition to the terms defined in 53-24-103, MCA, the following definitions shall apply in the interpretation and enforcement of the rules in this subchapter: (1) "Administrator" means the person in charge, care, or control (2) "Admission" means specific tasks necessary to admit a person to
(3) "Adolescent" means a person 17 years of age or younger for purposes of receiving services in a SUDF. Persons 18, 19, and 20 may be defined as an adolescent if enrolled in accredited secondary school and the client assessment completed by a LAC or mental health professional determines their appropriateness for adolescent treatment.
(5) "American Society of Addiction Medicine (ASAM) Criteria" means guidelines for placement, continued stay, and transfer/discharge of individuals with addiction and co-occurring conditions, developed by the American Society of Addiction Medicine.
(a) presenting problem(s) and history of problem(s); (b) family history; (c) developmental history (including pregnancy, developmental milestones, temperament); (d) substance use history; (e) personal/social history; (f) legal history; (g) psychiatric history; (h) medical history; (i) spiritual history; (j) diagnostic interview and mental status examination; (k) physical health impressions; (l) diagnostic impressions; (m) needs, strengths, skills, and resources in each dimension; and (n) treatment recommendations.
(7) "Care management" means the management and coordination of services to meet individual treatment needs of a client and includes: (a) conducting a needs assessment; (b) developing, implementing, revising, or monitoring the care plan; (c) facilitating and coordinating treatment and services among other professionals and agencies; and (d) continuity of care provided by a designated member of the treatment team.
(8) "Care manager" means a designated staff member on the care team that delivers care management services to clients and works directly with each client to ensure they receive the right care at the right time by coordinating services and referrals and tracking clinical outcomes. (9) "Clinical director" means a Licensed Addiction Counselor, Licensed Clinical Social Worker, Licensed Clinical Professional Counselor, Licensed Marriage Family Therapist, or Clinical Psychologist responsible for the supervision and provision of skilled treatment services provided in a substance use disorder facility. The clinical director cannot be a licensure candidate.
(12) "Critical population" means an individual who may be in need of additional services and is a priority admission to a SUDF in the following order of priority: (a) pregnant injecting drug users; (b) pregnant substance abusers; (c) injecting drug users; (d) individuals infected with the etiologic agent for acquired immune deficiency, Hepatitis B and/or C, tuberculosis (TB),or any sexually transmitted infection; and (e) women with dependent children.
(14) "Direct care" means the provision of providing awake supervision, treatment, or services to clients in a SUDF.
(15) "Educational group" means structured service provided in a group setting designed to educate clients about substance abuse and the consequences of substance abuse. It may be provided by rehabilitation aides or other direct care staff. (16) "Guardian" means a person appointed by a court to make medical, and possibly financial, decisions as provided in Title 72, chapter 5, MCA. (17) "Individualized treatment plan" means a written document as described in ARM 37.106.1440, identifying the client's medical needs, clinical needs, goals, objectives, and interventions. (18) "Interdisciplinary team" means a group of licensed or certified individuals trained in different professions, disciplines, or service areas who function interactively and interdependently in conducting a client's biopsychosocial assessment, individualized treatment plan, and treatment services.
(20) "Medical director" means a physician, licensed under requirements set forth in Title 37, chapter 3, MCA, who establishes and oversees written protocols for the provision of medical services and medication management provided in a medically monitored inpatient substance use disorder residential facility. (20) remains the same, but is renumbered (21). (22) "Mental health professional" means a clinical psychologist, licensed clinical social worker (LCSW), licensed clinical professional counselor (LCPC), and licensed marriage and family therapist (LMFT), licensed under requirements pursuant to Title 37, chapters 17, 22, 23, or 37, MCA; or a social worker licensure candidate; professional counselor licensure candidate; or marriage and family therapist licensure candidate, registered under requirements pursuant to Title 37, chapters 22, 23, or 37, MCA. Mental health professionals cannot assume the role of care manager. (23) "Nurse practitioner" means a person licensed under Title 37, chapter 8, MCA. (21) remains the same, but is renumbered (24).
(25) "Physical restraint" means a personal restriction that immobilizes or reduces the ability of the free movement of an individual's arms, legs, or head. The term does not include physical escort. Physical restraint may be imposed only in emergency circumstances and only to ensure the immediate physical safety of the adolescent, a staff member, or others, when less restrictive interventions have been determined to be ineffective. (26) "Physician" means a person licensed under requirements pursuant to Title 37, chapter 3, MCA. (27) "Physician assistant" means a person licensed under requirements pursuant to Title 37, chapter 20, MCA. (28) "Progress note" means a written record of a treatment session or service contact. It is individualized to each client for each separate session or service, and includes the following: (a) date, time in/time out, and duration of session; (b) participant names; (c) type and summary of session or service; (d) client's participation; (e) documentation of measurable progress toward ITP goals and objectives; (f) the name and signature (with date of completion) of the staff member providing the session or service; and (g) documentation in the client's file within seven days of the treatment session or service contact, or there must be documentation why this did not occur. (29) "Psychosocial rehabilitation" means a service that includes assisting adults with restoring skills related to exhibiting appropriate behavior and living with greater independence and personal choice. Services maximize the skills needed to function in the home, workplace, and community setting. Services can be provided by a rehabilitation aide. (30) "Recovery residence" means a substance-free living environment that supports individuals in recovery from substance use disorders. Recovery residences do not provide clinical services and are excluded from licensure by the department. (31) "Registered nurse" means a person licensed under requirements pursuant to Title 37, chapter 8, MCA. (32) "Rehabilitation aide" means a staff member of the SUDF who provides direct services to clients. Rehabilitation aides can provide psychosocial rehabilitation services under the supervision of the LAC or mental health professional staff and has documentation of training in the service provided. Rehabilitation aides must have a minimum of a high school diploma, high school equivalency test (HiSET), or general equivalency diploma (GED). (33) "Self-administration assistance" means providing necessary assistance to any resident in taking their medication, including: (a) removing medication containers from secured storage; (b) providing verbal suggestions, prompting, reminding, gesturing, or providing a written guide for self-administrating medications; (c) handing a prefilled, labeled medication holder, labeled unit dose container, syringe or original marked, labeled container from the pharmacy, or a medication organizer as described in ARM 37.106.2848 to the resident; (d) opening the lid of the marked, labeled container for the resident; (e) guiding the hand of the resident to self-administer the medication; (f) holding and assisting the resident in drinking fluid to assist in the swallowing of oral medications; and (g) assisting with removal of a medication from a container for residents with a physical disability which prevents independence in the act. (34) "Serious incident" means any one of the following events that occurs at the facility or while participating in a facility activity: (a) death; (b) suicide attempt; (c) known or suspected abuse, neglect, or exploitation of a client; (d) physical or sexual assault; (e) use of physical force or restraints; (f) event that causes or contributes to serious injury, illness, or death of any person or poses a serious risk to the health, safety, or welfare of any person; (g) serious physical plant damage; (h) a severe weather event that presents a substantial threat to facility operation or client safety; (i) bomb threat; and (j) alleged unlawful conduct or criminal activity. (35) "Skilled treatment services" means structured services such as individual and group counseling, medication management, family therapy, educational groups, psychosocial rehabilitation, occupational and recreational therapy, and other therapies provided to the client. Skilled treatment services do not include attendance at self/mutual help meetings, volunteer activities, or homework assignments such as watching videos, journaling, and workbooks. (36) "Staff member" means a person that provides any type of service in the SUDF and is either employed, contracted, a volunteer, or participating in a trainee/intern program. (37) "Substance use disorder" means chemical dependency, as defined in 53-24-103, MCA. (38) "Substance use disorder facility (SUDF)" means a chemical dependency facility, as defined in 50-5-101, MCA.
(39) "Treatment plan review" means clinical review of the client's progress in treatment and determination of whether the client meets the continuing, transfer, or discharge criteria outlined in the ASAM Criteria for the current level of care. (40) "Withdrawal management" means services required for dimension one in the ASAM Criteria; acute intoxication and/or withdrawal potential.
AUTH: 50-5-103, 53-24-208, 53-24-301, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
37.106.1415 APPLICATION OF OTHER RULES (1) To the extent that other licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of this subchapter, the terms of this subchapter shall apply to a
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
37.106.1420 POLICY AND PROCEDURE MANUAL REQUIREMENTS (1) Each (a) the philosophy of the (b) the (c) a description of the population the
(e) screening procedures for all referrals;
(n) drug and alcohol laboratory testing methods, collection, and storage procedures, including: (i) how testing is used as part of a non-punitive therapeutic process including how the use of testing and results become part of the client's treatment plan; and (ii) process addressing client refusal to submit for laboratory testing or drug and alcohol screening and confirmation testing; (o) arranging for medical and mental health services when clinically indicated in the biopsychosocial assessment or treatment plan reviews for all clients and within 48 hours of admission for critical populations; (p) screening clients for critical populations at the time of admission; (q) limitations and requirements of group counseling sessions to include client/staff member ratio, appropriate for the level of care being rendered; (r) provision of services to family members and significant others; (s) medical emergencies; (t) youth program policies in [NEW RULE X]; and (u) any additional policy and procedures as required by this subchapter.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-207, 53-24-208, 53-24-306, 76-2-411, MCA
37.106.1425 (2) The governing body must provide organizational oversight to ensure that adequate resources are available to ensure staff members provide safe and adequate care. (3) The governing body must establish written policies and procedures that: (a) govern the organization and functions of the SUDF; (b) establish procedures for selecting and periodically evaluating a qualified administrator to ensure the administrator carries out the goals and policies of the governing body; (c) implement all state and federal requirements; (d) establish accounting and fiscal procedures; (e) describe how updates and changes are reviewed with and implemented by staff member(s); and (f) include annual review of the quality improvement report by the governing body. (4) Each SUDF must have an administrator that is responsible for, and must be familiar with the daily operation of, the SUDF. (5) The administrator must; (a) be qualified through appropriate knowledge, experience, and capabilities to supervise and administer the services properly; (b) be available, or ensure a designated alternate who has similar qualifications is available, to carry out the goals, objectives, and standards of the governing body and to implement the rules of this subchapter; and (c) review progress on the quality improvement plan with the governing body on a quarterly basis. (6) The SUDF must maintain professional liability and general liability insurance.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-301, MCA
37.106.1430 (a) (b) (c) (d) (e) (f)
(i) trainee/intern or volunteer requirements as required in ARM 37.106.1435.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, MCA
37.106.1432 PERSONNEL FILE REQUIREMENTS (1) The
(b) a Montana Child Protective Services check for SUDFs serving or housing adolescents; (c) (d) an annual performance review
(e) copies of (f) evidence of an independent contractor status and contractual agreements for contracted (g) a signed statement acknowledging the (h) and (i) remain the same. (j) a copy of a current job description (i) through (iii) remain the same.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, MCA
37.106.1435 (a) policies and practices assuring the safety of clients; (b) a description of the (c) a description of how supervision of the trainees/interns or volunteers will be provided; (d) policies and (e) a written agreement with each educational institution using the (i) a description of the nature and scope of student activity at the
(2) Volunteers must not be part of client/staff ratios or provide unsupervised direct care to clients. (3) Volunteers must meet the requirements of ARM 37.106.1432(1)(a), (b), (c). (4) For purposes of this subchapter, trainees/interns are considered to be a staff member of the SUDF.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, MCA
37.106.1440 CLINICAL REQUIREMENTS
(1) Each client must have an individualized treatment plan (ITP) developed by an interdisciplinary treatment team. (2) ITPs must include: (a) the client's name, diagnoses, treatment plan date, and treatment plan review dates; (b) the names of treatment team members who are involved in the client's treatment; (c) the individualized client strengths; (d) the problem area(s) that will be the focus of treatment to include symptoms, behaviors, and/or functional impairments; (e) the treatment goals, objectives, and interventions that are person centered and recovery oriented; (f) the description of the type, duration, and frequency of the intervention(s) and services(s); (g) expected dates of completion; (h) an educational plan for youth; and (i) the client's level of functioning that will indicate when a service is no longer required. (3) ITPs and treatment plan reviews must be completed with the client and include the client's legal guardian and at least one qualified licensed professional. The treatment plan and treatment plan reviews must be signed and dated by interdisciplinary team members, the client, and the client's legal guardian (if applicable). (a) Additional service providers must be contacted and encouraged to participate as clinically indicated. (4) ITPs must be completed within: (a) 24 hours of admission for ASAM 3.7, 3.7-WM and 3.2-WM; (b) 48 hours of admission for ASAM 3.5; (c) seven days of admission for ASAM 3.3 and 3.1; and (d) five contacts or 21 days from the first contact, whichever is later, for outpatient facilities. (5) Treatment plan reviews must be completed: (a) every three days from the admission date for ASAM 3.7, 3.7-WM and 3.2-WM. (b) every seven days from the admission date for ASAM 3.5; (c) every 30 days from the admission date for ASAM 3.1; (d) every 14 days for from the admission date for ASAM 2.5; and (e) every 90 days from the admission date for outpatient facilities. (6) Treatment plan reviews must include: (a) documentation regarding the client's response to treatment; (b) review of the client's progress in all six dimensions; and (c) progress towards goals and objectives that result in either an amended ITP or a statement of the continued appropriateness of the existing plan. (7) A continuing care plan must be given to the client and, if applicable, the client's legal guardian/parent, representative or guardian at the time of discharge and must include, if applicable: (a) client's name, date of birth, admission and discharge dates, and reason for placement and discharge; (b) a written summary of services provided, including the client's participation and progress in the SUDF, contact information of licensed health care providers who conducted evaluations and treatment, and condition of the client at the time of discharge; (c) goals for continuing care and recovery; (d) community substance use treatment provider's contact name, contact number, and time and date of an initial appointment; (e) health care follow-up including provider's contact name, contact number, and initial appointment (if necessary); (f) current medications, dosage taken, number of times per day, and name of prescribing licensed health care professional; (g) name and contact number of the client's recovery supports; (h) housing and employment plan; (i) medical, dental, and psychiatric care received during placement; (j) adolescent's educational status (if applicable); and (k) signature of the client and of the staff member who prepared the plan.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-207, 53-24-208, 76-2-411, MCA
37.106.1450 CLIENT RIGHTS (a) (b) (c) (d) (e) (f) (g) (h)
(i) educational services provided to adolescents within inpatient/residential settings in accordance with Montana state law;
(k) reasonable visitation and access to telephone communication within inpatient/residential settings; (l) send and receive mail within inpatient/residential settings; (m) regular physical exercise several times per week within inpatient/residential settings; and (n) be given a 30-day notice in the event of a SUDF closure or treatment service cancellation and: (i) provided assistance with relocation into similar treatment services, if available; (ii) be given refunds to which the client is entitled; and (iii) be advised how to access records to which the client is entitled. (2) The SUDF must inform each client and his or her representative, in an understandable manner, of the rights policy, treatment methods, and rules applicable to the client, at the time of admission or as soon thereafter as the client is capable of rational communication. (3) The client and staff member reviewing the policy must sign a statement acknowledging the review. The statement must be maintained in the client's record. (4) The SUDF must post a copy of clients' rights in a conspicuous place in the facility accessible to clients and staff members.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-306, 76-2-411, MCA
37.106.1452 CLIENT RECORD MAINTENANCE AND SYSTEM REQUIREMENTS (1) Each
(2) Each SUDF must have written procedures which regulate and control access to and use of client records.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-306, 76-2-411, MCA
37.106.1454 CLIENT RECORD CONTENT REQUIREMENTS (1) The (a) through (c) remain the same. (d) signed documentation the client was informed of federal confidentiality requirements and received a copy of the client notice as required in [NEW RULE VI]; (e) (f) a voluntary consent to treatment signed and dated by the client or legal guardian; (g) individualized treatment plan and treatment plan reviews; (h) progress notes; (i) (j) continuing care plan; (j) and (k) remain the same, but are renumbered (k) and (l).
(m) remains the same, but is renumbered (n).
(p) documentation of any client-filed written grievances and resolution; (q) documentation the client received a copy of the client rights policy and the client's signature indicating he/she received the policy; and (s) documentation of school educational courses attended or provided.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
37.106.1460 QUALITY MANAGEMENT REQUIREMENTS (1) The (2) The quality management committee must meet on a quarterly basis and is responsible for: (a) developing a written plan for a continuous quality improvement program that is applicable to the entire organization (b) remains the same.
(d) and (e) remain the same, but are renumbered (c) and (d). (3) The quality improvement program must include at a minimum (a) and (b) remain the same. (c) clinical services; (d) client outcomes (e) a process for reviewing serious incidents, grievances and complaints, and medication errors. (4) The SUDF must prepare and maintain on file an annual report including improvements made as a result of the quality management plan.
AUTH: 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
37.106.1470 FACILITY REQUIREMENTS (1)
(4) An inpatient or residential SUDF must have an annual fire inspection conducted by the state fire marshal or by the authority having jurisdiction, and must maintain a record of the inspection for at least three years following the date of the inspection. (5) Exit doors shall not include locks which prevent evacuation, except as approved by the fire marshal and building codes agency having jurisdiction. (6) Stairways, halls doorways, passageways and exits from rooms and from the facility must be kept unobstructed at all times. (7) All exterior pathways, entrances, and exit ways shall be of hard, smooth material, and be unobstructed and in good repair at all times. (8) A 2A10BC portable fire extinguisher shall be available on each floor of the facility or as required by the fire authority having jurisdiction. (9) Portable fire extinguishers must be inspected, recharged, and tagged at least once a year by a person certified by the state to perform these services. (10) A smoke detector, approved by a recognized testing laboratory, which is properly maintained and regularly tested, must be located on each level and in all sleeping areas, bedroom hallways, and common living areas, with the exception of the kitchen and bathrooms of a SUDF or as required by the fire authority having jurisdiction. (11) If individual battery-operated smoke detectors are used, the following maintenance is required: (a) smoke detectors must be tested at least once a month to ensure that they are operating correctly; (b) new operating batteries must be installed at least once each calendar year; and (c) documentation demonstrating required maintenance must be kept on-site for a period of 24 months. (12) Garbage and refuse must be:
(b) disposed of daily and removed from the property at least weekly to prevent the development of odor and attraction of insects and rodents.
(17) Poison control and emergency contacts must be posted at each telephone. (18) Facilities must have a first aid kit readily available on each floor. (19) Measures must be in place to ensure containers of poisonous and toxic materials are stored safely and contain a legible manufacturer's label or material safety data (MSD) sheets. (20) Maintenance and cleaning tools must be maintained and stored in a safe and orderly manner.
(a)
(c) accommodate no more than four clients;
(C) remains the same, but is renumbered (h).
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
37.106.1475 (a)
(d) a RN or licensed practical nurse (LPN) on-site 24 hours a day, seven days a week; (e) additional RNs, LPNs or certified nurse aides (CNA) in sufficient numbers to assist in the administration of medical protocols and assure the client's safety. LPNs and CNAs must be under the supervision of the RN; (f) licensed addiction counselors or mental health professionals in sufficient numbers to provide therapeutic services to clients with substance use and mental disorders, as described by this chapter and in accordance with the clients' individualized treatment plans; (g) a licensed addiction counselor or mental health professional must be on-site or on-call 16 hours a day, seven days a week; (h) care managers in sufficient numbers to provide adequate services to clients; and (i) rehabilitation aides in sufficient number to provide on-site 24 hours a day, seven days a week staffing patterns to ensure the safety of clients and to provide direct care services and appropriate supervision of clients.
(a) a physical examination and screening conducted by a physician, nurse practitioner, or a physician assistant of clients on-site within 24 hours of admission, to identify medical needs for health problems and screen for communicable diseases; (b) a comprehensive nursing assessment that includes a mental health screening and evaluates the need for acute intoxication and withdrawal management services completed by a registered nurse at the time of admission; and (c) medication management. (3) Daily clinical and medical services must be provided on-site by an interdisciplinary team seven days a week. (4) The SUDF must provide recreational activities seven days a week. (5) All progress notes must be completed in a timely manner and before the next session of the same type or there must be documentation why this did not occur. (6) The SUDF must ensure a coordinated transfer to an acute care hospital or other licensed health care facilities. (7) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
37.106.1480
(g) The SUDF must have licensed addiction counselors (LAC) or mental health professionals in sufficient numbers to provide counseling and therapy services as described in this chapter and in accordance with the client's individualized treatment plan. (h) The initial biopsychosocial assessment indicating this level of care must be reviewed by a licensed physician, nurse practitioner, or physician assistant during the admission process. (i) The SUDF must provide daily clinical services to address the needs of each client. Clinical services may include medical services, individual group therapy, and withdrawal support as required in the client's individualized treatment plan.
(k) All progress notes must be completed in a timely manner and before the next session of the same type, or there must be documentation why this did not occur. (l) Coordination of necessary services (medical, laboratory, toxicology, psychiatric, psychological, emergency) or other levels of care must be available through direct affiliation or referral processes. (2) The facility providing clinically managed residential withdrawal management (ASAM 3.2) must not exceed the number of inpatient or residential beds licensed for pursuant to 50-5-101 MCA. (3) To be licensed to provide medically managed inpatient withdrawal, as defined as ASAM Level 3.7-WM, a provider must be licensed as an inpatient substance use disorder facility and meet the requirements under ARM 37.106.1475 and the following: (a) a RN must be on-site 24 hours a day, seven days a week to monitor clients receiving acute intoxication or withdrawal management services and administer services according to physician approved protocols; (b) the facility must be equipped for clients who are impaired due to substances and who require assistive safety devices, as written in the physician approved protocols; (c) all bathtubs and showers must be equipped with a safety handrail; and (d) emergency equipment to include: (i) oxygen; (ii) automatic external defibrillator (AED); (iii) suction machine; and (iv) other emergency equipment according to the physician approved protocols for responding to client health emergencies.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
37.106.1485
(1) In addition to the licensing requirements in [NEW RULE XVI], a SUDF operating as a single sex parent and children ASAM 3.1 facility, must meet the following requirements: (a) care management services must address the needs of the client's children in care; (b) parenting skills must be addressed with evidence-based models that focus on the demands of being a parent in recovery; and (c) the SUDF must provide age-appropriate services to meet the children's needs. Services include childcare, medical appointments, legal services, transportation, educational services, and recreational services. (2) Cleaning materials, flammable liquids, detergents, aerosol cans, and other poisonous and toxic materials must be kept in their original containers and in a place inaccessible to children. The materials must be used in such a way that will not contaminate play surfaces, food, food preparation areas, or constitute a hazard to the children. (3) No extension cords can be used as permanent wiring. All appliances, lamp cords, and exposed light sockets must be suitably protected to prevent electrocution. (4) Indoor and outdoor play areas must be clean, reasonably neat, and free from accumulation of dirt, rubbish, or other health hazards. (5) Any outdoor play area must be maintained free from hazards such as wells, machinery, and animal waste. If any part of the play area is adjacent to a busy roadway, drainage or irrigation ditch, stream, large holes, or other hazardous areas, the play area must be enclosed with a fence in good repair that is at least four feet high without any holes or spaces greater than four inches in diameter or natural barriers to restrict children from these areas. (6) Outdoor play areas must be designed to ensure all areas are always visible and easily supervised by staff members. (7) Outdoor equipment, such as climbing apparatus, slides, and swings, must be anchored firmly, and placed in a safe location according to manufacturer's instructions. Recommended ground covers under these items include sand, fine gravel, or woodchips with a depth of the ground cover being at least six inches. (8) Trampolines are prohibited for use by children in care. (9) Toys, play equipment, and any other equipment used by children must be of substantial construction and free from rough edges, sharp corners, splinters, unguarded ladders on slides, and must be kept in good repair and well maintained. (10) Toys and objects with a diameter of less than one inch (2.5 centimeters), objects with removable parts with a diameter of less than one inch (2.5 centimeters), plastic bags, Styrofoam objects, and balloons must not be accessible to children who are still placing objects in their mouths. (11) The Emergency Montana Poison Control Center number, (800) 222-1222, must be posted at all telephone locations in the facility. (12) Use of waterbeds, water mattresses, gel pads, or sheepskin covers for children's sleeping surfaces is prohibited. (13) Each infant under 18 months of age must be provided with a crib for sleeping. (14) Each child 18 months of age and older must be provided with a bed for sleeping. (15) Cribs must be made of durable, cleanable, nontoxic material, and have secured latching devices. (16) Cribs must have no more than 2 and 3/8 inches of space between vertical slats. (17) Cribs must meet requirements for full-size baby cribs and non-full-size baby cribs as specified by the Consumer Product Safety Commission at 16 CFR Part 1219 and 16 CFR Part 1220 (2011), incorporated by these references. Copies of the requirements for full-size baby cribs and non-full-size baby cribs are available at https://www.cpsc.gov/SafeSleep. (18) Crib mattresses must fit snugly to prevent the infant from being caught between the mattress and crib siderail. Crib mattresses must be waterproof and easily sanitized. (19) Cribs, cots, or mats must be thoroughly cleansed before assignment to another infant or toddler. (20) Age-appropriate feeding equipment must be provided for every four infants or toddlers. This includes safe high-chairs, baby feeding tables, booster seats, and child-size tables and chairs. This equipment must be used in accordance with the manufacturer's instructions and must be appropriate for the age of the child using the equipment. Portable high-chairs that hook onto tables are prohibited. (21) If the SUDF chooses to lock the facility door to prevent unauthorized access to the facility or to prevent a child from escaping, the facility must have no lock or fastening device which prevents free escape from the interior. Requirements include: (a) locking devices must not require a key, a tool, or special knowledge or effort to open the door from the inside; and (b) locked doors must be easily opened with one motion from the inside of the facility.
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
5. The department proposes to repeal the following rules:
37.27.108 ADMINISTRATIVE MANAGEMENT – GOVERNING BODY
AUTH: 53-24-209, MCA IMP: 53-24-208, MCA
37.27.121 ALL PROGRAMS – PERSONNEL, STAFF DEVELOPMENT AND CERTIFICATION
AUTH: 53-24-204, 53-24-208, 53-24-215, MCA IMP: 53-24-204, 53-24-208, MCA
37.27.136 OUTPATIENT COMPONENT REQUIREMENTS
AUTH: 53-24-204, 53-24-208, MCA IMP: 53-24-208, MCA
37.27.137 DAY TREATMENT COMPONENT REQUIREMENTS
AUTH: 53-24-208, MCA IMP: 53-24-208, MCA
37.27.138 INTENSIVE OUTPATIENT TREATMENT COMPONENT REQUIREMENT
AUTH: 53-24-208, MCA IMP: 53-24-208, MCA
37.106.1401 MINIMUM STANDARDS FOR CHEMICAL DEPENDENCY FACILITIES
AUTH: 50-5-103, MCA IMP: 50-5-201, 50-8-101, 50-8-102, 50-8-105, MCA
37.106.1462 REQUIRED OUTCOME MEASURES
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 76-2-411, MCA
37.106.1482 HALFWAY HOUSE COMMUNITY-BASED RESIDENTIAL PROGRAM REQUIREMENTS
AUTH: 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
37.106.1487 HALFWAY HOUSE SINGLE GENDER RESIDENTIAL HOMES (ASAM LEVEL III.5 – HIGH INTENSITY)
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
37.106.1491 HALFWAY HOUSE COMMUNITY-BASED SINGLE GENDER RESIDENTIAL HOMES (ASAM LEVEL III.1 – LOW INTENSITY)
AUTH: 50-5-103, 53-24-208, MCA IMP: 50-5-101, 50-5-103, 53-24-208, 53-24-209, 76-2-411, MCA
6 STATEMENT OF REASONABLE NECESSITY
This rulemaking notice is part of the department's Healing and Ending Addiction through Recovery and Treatment (HEART) Initiative. The HEART Initiative will establish a comprehensive continuum of care to address Montana's behavioral health needs, which include services for mental health and substance use disorder treatment. The HEART Initiative represents the state's commitment to expanding coverage and promoting access to prevention, crisis intervention, treatment, and recovery services for eligible Montanans.
The department's Office of Inspector General (OIG) has worked in collaboration with the Behavioral Health and Developmental Disabilities Division (BHDD) to amend current licensure and state approval rules for substance use disorder facilities (SUDF).
Current substance use disorder (SUD) program facility licensing rules under the OIG are not aligned with the current American Society of Addiction Medicine (ASAM) Criteria. The ASAM Criteria is the most widely used and comprehensive set of guidelines for placement, continued stay, transfer, or discharge of individuals with addiction and co-occurring conditions. OIG and BHDD have worked together to implement the ASAM criteria to improve assessment and outcomes-driven treatment and recovery services for adults and adolescents. Current licensing rules do not include all ASAM levels of care and, in some instances, have language that conflicts with the current ASAM Criteria. State approval rules under the BHDD Division for SUD programs currently include requirements that generally fall under licensing responsibility. With the proposed amended rules, the department attempts to implement licensure standards for all levels of care and reduce or eliminate any duplication and conflict between state licensure and approval rules.
Additional changes include updating outdated terminology, repealing unnecessary or redundant rules, amending rules for accuracy and consistency, and providing better organization for ease of use by the regulated community. The proposed rulemaking transfers oversight of outpatient SUDFs to OIG, while maintaining quality of care reviews with BHDD. The proposed rules also allow BHDD to streamline the approval process and to delineate between prevention providers, individual licensed addiction counselors, and facilities licensed by OIG.
Additionally, BHDD is proposing changes to the AMDD Medicaid Services Provider Manual for SUD and Adult Mental Health and the AMDD Non-Medicaid Services Provider Manual for SUD and Adult Mental Health. The AMDD Medicaid and Non-Medicaid Manuals need to be updated to reflect ASAM requirements for reimbursement and correct other inconsistencies that have been identified through provider engagement. These changes will allow BHDD to expand the behavioral health continuum of care and ensure consistency in the delivery of those services. BHDD would amend policies in the manuals that include the following changes:
NEW RULE I The department proposes to adopt NEW RULE I to enable it to implement sanctions for all noncompliant programs. This is necessary to ensure the safety of all individuals receiving services and provide for appropriate oversight of programs. The rule describes sanctions that result from violation of state or federal regulations.
NEW RULE II The department proposes to adopt NEW RULE II to ensure compliance with 42 CFR, Part 2, for confidentiality of client information. The department proposes NEW RULE II to replace part of ARM 37.27.116 and consolidate confidentiality requirements into one rule. It is also necessary to ensure all information provided to these providers remain confidential and is only released to individuals or entities as required or permitted by state and federal law.
NEW RULE III The department proposes to adopt NEW RULE III to implement requirements for communicable disease control for individual and prevention providers. This mirrors the proposed requirement for facilities under OIG rules.
NEW RULE IV The department proposes to adopt NEW RULE IV to implement requirements on abuse, neglect, and exploitation with respect to individual and prevention providers. This mirrors the proposed requirement for facilities under OIG rules. This is necessary to ensure the safety of all individuals receiving services and to protect such individuals from abuse, neglect, and exploitation. The rule gives clear guidance and describes what is required for staff training and procedures to follow when incidents of suspected abuse, neglect, and exploitation occur.
NEW RULE V The department proposes to adopt NEW RULE V and incorporate the BHDD Non-Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health due to the addition of Non-Medicaid mental health services to this manual.
The substantive changes to non-Medicaid mental health services are explained elsewhere in this statement of reasonable necessity and represent alignment with the mental health services provided to Medicaid members. Aligning Medicaid and non-Medicaid mental health services among recipients allows the state to establish a comprehensive continuum of care to address Montana's behavioral health needs.
NEW RULE VI The department proposes to adopt NEW RULE VI to ensure compliance with 42 CFR, Part 2, for confidentiality of client information, to replace part of ARM 37.106.1420, and to consolidate confidentiality requirements into one rule. It is also necessary to ensure all information provided to the SUDF remains confidential and is only released to individuals or entities as required or permitted by state and federal law.
NEW RULE VII The department proposes to adopt NEW RULE VII to separate reporting requirements currently outlined in ARM 37.106.1420 for better organization and ease of use by the regulated community. It is necessary to include reporting requirements for serious incidents to determine if an investigation is required to verify whether licensing violations have occurred or if a situation exists that has the potential to cause harm.
NEW RULE VIII The department proposes to adopt NEW RULE VIII to separate reporting requirements currently outlined in ARM 37.106.1420 for better organization and ease of use by the regulated community. The proposed new rule combines reporting requirements for abuse, neglect, and exploitation with the facility's policies and procedures for handling suspected abuse, neglect, and exploitation within the facility. The proposed new rule is necessary to ensure the safety of all individuals receiving services within the SUDF from abuse and neglect. The rule gives clear guidance and describes what is required for staff training and procedures to follow when incidents of suspected abuse, neglect, and exploitation occur.
NEW RULE IX The department proposes to adopt NEW RULE IX to consolidate current and new training requirements under one rule. It is necessary for SUDFs to provide adequate training to staff to ensure patient safety and best practices are utilized so that staff are prepared to address the ever-changing needs of the SUDF and the individuals being served by the facility. Staff must be prepared to deal with a wide variety of possible scenarios, such as how to deal with crisis and emergency situations. Due to the difficult nature of individuals being served, providers need to implement effective de-escalation methods and assure staff competency in these procedures. The proposed new rule provides training, timelines, and expectations. When staff are not adequately trained to provide appropriate care, the quality of care is compromised, and staff and individuals in care are at risk. Requirements for ongoing training give staff the opportunity to remain current with industry treatment standards and improve their knowledge and skills to deal with difficult individuals with substance use disorder issues.
NEW RULE X The department proposes to adopt NEW RULE X to provide the necessary regulations specific to SUDFs serving adolescents. Programs serving adolescents must differ from treatment of adults and should be designed to meet adolescents' different developmental needs as emotional, cognitive, physical, social, and moral development. Adaptation of adult treatment models is not clinically appropriate for adolescent treatment. The proposed new rule allows for the placement of adolescents up to the age of 21 in an adolescent-serving SUDF, if determined clinically appropriate. The new rule includes provisions for adolescent communication with guardians, supervision requirements specific to serving adolescents, requirements for educational activities, and guidelines for the residential arrangements of adolescents within the facility.
The rule provides clear guidelines in the application of crisis intervention and physical restraints. The rule incorporates federal guidelines pertaining to physical restraints, including when the use of physical restraints is acceptable and when it is prohibited. Since the use of physical restraint is a serious behavioral management technique and is to be used only in emergency situations, it is necessary to have strict guidelines to protect the adolescent, other adolescents placed in the SUDF, and the staff of a SUDF.
NEW RULE XI The department proposes to adopt NEW RULE XI to clearly outline procedures for the safe administration, storage, and documentation of medication. The proposed new rule is necessary to provide for the safety of clients by ensuring that the client is given the proper medication, in the appropriate dosage, at the appropriate time. The proposed rule clarifies medication administration requirements for substance use disorder facilities that do not have nursing staff on site 24 hours a day, seven days a week. It further prohibits the use of medication as a means of discipline. It is necessary to include a rule prohibiting facilities from requiring clients to discontinue the use of prescribed medications to align with the Montana HEART requirements.
NEW RULE XII The department proposes to adopt NEW RULE XII to provide the necessary policy and procedure requirements for pets, which does not include service animals. Animals, including pets, can be a source of illness for people. Hand washing and appropriate pet care is the most important way to reduce the spread of infection. It is necessary to establish criteria to ensure that pets will be free and clear of health hazards and not present a danger to visitors, or to those who reside or work in the facility.
NEW RULE XIII The department proposes to adopt NEW RULE XIII to separate food requirements under ARM 37.106.1470(14) and place all food service requirements under one rule. The proposed new rule is necessary to ensure programs meet the minimum requirements needed for safe food handling, preparation, and sanitation.
NEW RULE XIV The department proposes to adopt NEW RULE XIV to align this level of care with the ASAM 3.5 criteria. The current licensure rules allow ASAM 3.5 services to be provided under two separate licenses: (1) inpatient/residential facility licensed under ARM 37.106.1475; and (2) residential halfway house licensed under ARM 37.106.1487. The two sets of rules required different levels of staffing and clinical requirements, but are reimbursed at the same level. Neither rule is aligned with the current ASAM 3.5 Criteria. This level of care provides residential care to individuals who do not require 24 hour medical or nursing interventions, but do require a structured 24 hour supportive treatment environment to initiate or continue a recovery process. The client's multidimensional needs are of such severity that they cannot safely be treated in a less intensive setting. The rule replaces the current requirement for nursing staff availability 24 hours with the correct ASAM guideline requiring clinical staff availability 24 hours per day. The rule includes a specific treatment requirement to focus on the client's substance use and addictive disorders and significant social and psychological problems. It is necessary to require daily planned clinical program activities to stabilize and maintain stabilization of the client's addiction symptoms and help him or her develop recovery skills. It is necessary to include a daily requirement of a certain number of hours of clinical services and activities, to ensure clinical treatment is provided daily, including weekends, as this level of care is intended to be short term.
NEW RULE XV The department proposes to adopt NEW RULE XV to replace ARM 37.106.1487 and align with current ASAM criteria for ASAM 3.3 Clinically Managed Population-Specific High Intensity Residential (adult only) substance use disorder facilities. The rule provides requirements for a structured 24 hour residential recovery environment in combination with high intensity clinical services provided in a manner to meet the functional limitations of clients and to support recovery from substance related disorders. It is necessary to require daily planned clinical program activities and services to stabilize and maintain stabilization of the client's addiction symptoms and help him or her develop and apply recovery skills.
NEW RULE XVI The department proposes to adopt NEW RULE XVI to replace ARM 37.106.1491 and align with current ASAM criteria for ASAM 3.1 Clinically Managed Low Intensity Residential (adult or adolescent) SUDF. The rule provides low intensity residential care to individuals who do not require 24 hour medical or nursing interventions, but do require a structured 24 hour supportive treatment environment to practice and integrate their recovery and coping skills. It is necessary to require weekly planned clinical services and activities in order to facilitate the application of recovery skills, relapse prevention, and emotional coping strategies.
NEW RULE XVII The department proposes to adopt NEW RULE XVII to transfer oversight responsibility of facilities providing this level of care to OIG from BHDD. The rule outlines all requirements for a Partial Hospitalization SUDF (which is referred to as Day Treatment in ARM 37.27.137). The proposed new rule aligns with ASAM Criteria for ASAM 2.5 Partial Hospitalization. The proposed new rule outlines requirements for weekly scheduled skilled treatment services provided by an interdisciplinary team of appropriately licensed and trained staff on-site a minimum of 20 hours per week. The rule provides partial hospitalization care to individuals who do not require 24 hour intensive supervision, but do require a structured supportive treatment environment to initiate or continue a recovery process. Weekly planned clinical program activities are necessary to stabilize and maintain stabilization of the client's addiction symptoms and to help him or her develop recovery skills.
NEW RULE XVIII The department proposes to adopt NEW RULE XVIII to transfer oversight responsibility of outpatient SUDFs to OIG from BHDD. The proposed new rule requires skilled treatment services be provided by an interdisciplinary team of appropriately licensed and trained staff.
NEW RULE XIX The department proposes to adopt NEW RULE XIX to separate part of ARM 37.106.1432(1) and ARM 37.106.1470(10) and consolidate all requirements for communicable disease control into one rule.
NEW RULE XX The department proposes to adopt NEW RULE XX to include care management requirements in all levels of care for SUDFs. Care management is necessary to enhance the scope of addiction treatment and the recovery continuum for clients with substance abuse disorders.
ARM 37.27.101 The department proposes to amend this rule to indicate that state approval is required for access to alcohol tax dollars under 53-24-108, MCA. It also lists each ASAM level of care and additional specialty services that a program can identify in their state approval application. This is needed as programs can be licensed for more than one level of care, and the department will need to verify that the provider is qualified to deliver the level(s) of care requested in their application.
ARM 37.27.102 The department proposes to amend this rule to remove antiquated and unnecessary language, update definitions, and include new definitions to incorporate information addressed in these rules. Updated and new definitions are necessary to ensure terminology used throughout the proposed rules allows all readers to have a common understanding of the word or subject.
ARM 37.27.105 The department proposes to amend this rule to read BHDD instead of AMDD. This is necessary to reflect the current division name.
ARM 37.27.106 The department proposes to amend this rule to clarify that this rule applies to facilities that are applying to become state approved. Prevention providers are approved under ARM 37.27.105 and individual licensed addiction counselors (LAC) will be approved under ARM 37.27.107. The department proposes to remove provisions in ARM 37.27.106(1) and place them in ARM 37.27.101. This is necessary to delineate between prevention providers, individual LACs, and facilities.
ARM 37.27.107 The department proposes to amend this rule to clarify that this rule applies to individual providers who are LACs. Prevention providers are approved under ARM 37.27.105, and facilities will be approved under ARM 37.27.106. This is necessary to delineate between prevention providers, individual LACs, and facilities.
ARM 37.27.115 The department proposes to amend this rule to clarify program requirements regarding an individualized treatment plan, referrals to appropriate services, and prohibition on any requirement to discontinue the use of medication as a condition of treatment. It is necessary to expand language regarding individualized treatment plan (ITP) and referrals to ensure programs are compliant with Medicaid requirements and both state and federal regulations. It is also necessary to include rules prohibiting programs from requiring clients to discontinue the use of prescribed medications to align with the Montana HEART Initiative requirements.
ARM 37.27.116 The department proposes to amend the rule by updating the information regarding client rights when receiving treatment from individual and prevention providers. The proposed amendments are necessary to ensure client rights and ensure clients are informed of their rights, treatment methods, and rules of the program. This mirrors the proposed requirement for facilities under OIG rules.
ARM 37.27.120 The department proposes to amend this rule to remove language that exists in other rules of this subchapter, to indicate that documentation will conform with requirements outlined in the BHDD Medicaid Manual, and to provide clarification of the required annual self-evaluation. This is necessary to address provider comments regarding confusing and repetitive language. This is also necessary to ensure that providers are not being held to different documentation standards.
ARM 37.27.902 The department proposes to amend this rule to update the effective date of the BHDD Medicaid Manual and the BHDD Non Medicaid Manual to October 1, 2022. It is necessary to ensure that the manuals have SUD policies that reflect staffing requirements described in the ASAM Criteria and the OIG licensure rules, add a concurrent services table to clarify which services cannot be billed at the same time, and clean up language in several policies to provide better clarification of service delivery and address comments received through provider engagement.
ARM 37.88.101 The department proposes to amend this rule to update the effective date of the BHDD Medicaid Manual to October 1, 2022. It is necessary to ensure that the manuals have updated policies for Program of Assertive Community Treatment (PACT) and Montana Assertive Community Treatment (MACT) to ensure services are implemented as intended by national standards, a separate policy for Crisis Receiving Program to better align with the Crisis Now model, clean up language in several policies to provide better clarification of service delivery and address comments received through provider engagement, add a concurrent services table to clarify services that cannot be billed at the same time, and revise the SUD policies to add staffing requirements described in the ASAM Criteria and the OIG licensure rules.
ARM 37.106.1411 The department proposes to amend this rule to include a correct listing of SUDFs described in this rule.
ARM 37.106.1413 The department proposes to amend ARM 37.106.1413 by removing antiquated and unnecessary language, updating definitions, and including new definitions to incorporate information addressed in this rule. Updated and new definitions are necessary to ensure terminology used throughout the proposed rules allows all readers to have a common understanding of the word or subject.
ARM 37.106.1415 The department proposes to amend ARM 37.106.1415 to update terminology.
ARM 37.106.1420 The department proposes to amend this rule to consolidate all policy and procedure requirements, currently located in several rules, into one rule. An effective policy and procedure manual is essential for programs to maintain consistency in delivery of service. It is a tool to ensure new and existing employees understand the SUDF's expectations and requirements and to provide guidance to all staff in the SUDFs' specific methods and standards for how services are provided and work is performed.
It is necessary to add requirements to policy and procedure manuals to address the operation of the substance use facility required within this rule.
The department proposes to remove the provisions in ARM 37.97.1420(1)(j)(i) through (C) and place them in NEW RULE VI.
The department proposes to remove the provisions in ARM 37.97.1420(1)(l) through (n) and place them in NEW RULE VII.
The department proposes to remove the provisions in ARM 37.97.1420(1)(o) and (i) and place them in NEW RULE VIII.
The department proposes to remove (1)(f) through (vi) as the requirements are consolidated into the critical population definition and ARM 37.106.1420(1)(t).
ARM 37.106.1425 The department proposes to amend this rule to delineate the responsibilities of the governing body and administrator. The changes clarify the responsibilities of the administrator, and add the responsibilities of the governing body, which is necessary to provide organizations guidance and to ensure oversight of the SUDF. The proposed amendment outlines the role of the governing body to ensure the SUDF hires and maintains a qualified administrator.
ARM 37.106.1430 The department proposes to amend this rule to consolidate all requirements for personnel policies, currently in separate rules, into one rule. The proposed amendment provides facilities the ability to write their own policies and to outline what criminal history may disqualify applicants from working in the SUDF and to ensure the safety of clients.
The proposed amendment will remove unnecessary language, reorganize for ease of use by the regulated community, and remove requirements placed elsewhere in these rules.
ARM 37.106.1432 The department proposes to amend this rule to provide a location for documentation of personnel requirements throughout the rules and to correct wording and grammatical errors. The changes will require documentation showing compliance with the proposed rule requirements in personnel files.
ARM 37.106.1435 The department proposes to amend this rule to ensure that clients receive quality treatment and appropriate supervision from all individuals, volunteers, and interns.
ARM 37.106.1440 The department proposes to amend this rule to limit it to clarifying treatment plan requirements in all levels of care. Additional requirements for drug testing and critical populations have been moved to ARM 37.106.1420. (See the Statement of Reasonable Necessity for the amendments to ARM 37.106.1420.) The proposed rule focuses solely on treatment planning and increasing clarity and provides clear guidelines that align with industry standards and best practice. The proposed changes are necessary to incorporate requirements appropriate for all levels of care identified in the rule. The proposed changes are necessary to recognize the importance of developing a treatment plan implemented by an interdisciplinary team, while reviewing and updating the plan to ensure adequate treatment is being provided.
ARM 37.106.1450 The department proposes to amend the rule by updating the information regarding client rights when receiving treatment. The proposed amendments are necessary to ensure client rights and ensure clients are informed of their rights, treatment methods, and rules of the program. The department proposes to remove the provisions in ARM 37.106.1450(1)(i) through (ix) and place them in NEW RULE VI.
ARM 37.106.1452 The department proposes to amend this rule to provide minimum client record maintenance and system requirements that ensure confidentiality for client record systems are maintained as required by 42 CFR Part 2.
The department proposes to remove the current language in ARM 37.106(1)(c) and (d) and (2) as requirements regarding client record retention are located in ARM 37.106.314.
ARM 37.106.1454 The department proposes to amend this rule to specify information required in the client's case record to document services provided. Accurate records are essential for the continuity of care provided to clients. Adequate documentation allows all SUDF staff to be informed of essential information needed to provide quality services to clients.
ARM 37.106.1460 The department proposes to amend this rule to update and modify language and ensure the program's quality management process addresses all issues that would impact the quality of client care, and to require providers to develop a plan to improve organizational effectiveness.
ARM 37.106.1470 The department proposes to amend this rule to remove duplicative rules and update outdated and confusing language for ease of use by regulated community. The department proposes to remove current language under (2)(c), (3)(a), (b), (e), and (f) and (4)(a) through (f) as these requirements are located under Construction and Minimum Standards for All Health Care Facilities ARM 37.106.306, 37.106.320, 37.106.321, 37.106.322 and 37.106.331. Food and nutrition requirements under (14) have been moved to NEW RULE XIII. Pet requirements under (15) have been moved to NEW RULE XII.
The proposed changes are necessary to increase patient safety and include fire life safety standards as outlined in the International Building Code.
ARM 37.106.1475 The department proposes to amend this rule by removing licensure requirements for ASAM 3.5 level of care that have been proposed in NEW RULE XIV. The proposed amendments align requirements for inpatient SUDFs with ASAM Criteria for 3.7 level of care. The changes provide clarity on staffing and treatment requirements specifically for medically monitored inpatient facilities. Staffing requirements ensure the program is providing a planned, structured regimen of 24 hour professionally directed evaluation, observation, medical monitoring, and addiction treatment in an inpatient setting. Individuals admitted to this level of care may be experiencing physical and mental health problems and must have access to medical staff and clinical staff to address these needs.
Daily professional services are required to assess and address the client's individual needs, and clinical activities must be provided to stabilize the addictive and/or psychiatric symptoms. The provision of weekly professional services will enhance the client's understanding of his or her substance use and/or mental disorder.
ARM 37.106.1480 The department proposes to amend this rule to reorganize the structure of the rule, remove unnecessary language, update outdated language, provide clarification for SUDFs providing withdrawal management, and align licensure requirements to current ASAM Criteria.
The proposed amendment clarifies requirements for ASAM 3.2-WM that are confusing and conflict with inpatient 3.7-WM requirements. The proposed amendment implements staffing requirements for 3.2-WM programs to ensure adequate staffing is available to implement treatment requirements and follow physician approved protocols for monitoring clients that are intoxicated or experiencing withdrawal symptoms.
The department proposes to amend ARM 37.106.1480(2) as the majority of staffing requirements for 3.7WM level of care are under ARM 37.106.1475, ASAM 3.7 Medically Monitored Intensive Inpatient Requirements. Additional nursing and equipment requirements are proposed to monitor clients receiving acute intoxication or withdrawal management services.
The department proposes to remove current language under ARM 37.106.1480(1) as the information is located in the definition section of this rule.
The department proposes to remove current language under ARM 37.106.1480(3) as the rule incorrectly references ASAM Levels and contradicts requirements for medically monitored withdrawal management programs in amendments to ARM 37.106.1475(2).
ARM 37.106.1485 The department proposes to amend this rule to include licensing requirements specific to residential SUD facilities that serve single sex population of parents and their children. The proposed changes are necessary to help ensure the safety of the clients and their children and to provide the structure and support necessary to strengthen their recovery skills. The proposed amendment correctly aligns with ASAM Criteria for 3.1 level of care.
As the facilities admit clients with young children, it is necessary to include physical plant safety requirements to prevent harm to a child. Safety requirements address safe sleep, eating, and play, and poison control. Equipment is required to meet national safety standards.
ARM 37.27.108 The department proposes to repeal this rule because facilities that have an administrator and governing body will be licensed by OIG. This is also necessary because BHDD will approved individual LACs and prevention providers who would not have an administrator or governing body for purposes of treatment services.
ARM 37.27.121 The department proposes to repeal this rule because facilities with multiple personnel will be licensed by OIG. This is also necessary because BHDD lists the required license for individual providers under ARM 37.27.107.
ARM 37.27.136 The department proposes to repeal this rule because OIG will now be licensing outpatient facilities, and BHDD already approves individual LACs under ARM 37.27.107 for outpatient services that are within the scope of their individual licenses.
ARM 37.27.137 The department proposes to repeal this rule because OIG will now be licensing outpatient facilities, and BHDD will approve those licensed facilities for this level of care.
ARM 37.27.138 The department proposes to repeal this rule because OIG will now be licensing outpatient facilities, and BHDD will approve those licensed facilities for this level of care.
ARM 37.106.1401 The department proposes to repeal ARM 37.106.1401 because the types of SUDFs licensed by the department are now defined in ARM 37.106.1411 and 37.106.1413.
ARM 37.106.1462 The department proposes to repeal ARM 37.106.1462 as it no longer applies to SUDFs. The responsibility for collecting this data is not a licensure requirement. Outcome measures are included in ARM 37.106.1460.
ARM 37.106.1482 The department proposes to repeal ARM 37.106.1482 and 37.106.1489 because the types of SUDFs have been updated and defined in New Rules XIV, XV, and XVI.
ARM 37.106.1487 The department proposes to repeal ARM 37.106.1487 because the requirements will now be set forth in NEW RULE XIV. As stated above, NEW RULE XIV clarifies what services and treatment will be provided at the SUDF.
ARM 37.106.1489 The department proposes to repeal ARM 37.106.1482 and 37.106.1489 because the types of SUDFs have been updated and defined in NEW RULES XIV, XV, and XVI.
The department proposes to repeal ARM 37.106.1491 because the requirements will now be set forth in NEW RULE XVI. As stated above, NEW RULE XVI clarifies what services and treatment will be provided at the SUDF.
Fiscal Impact
The department anticipates no fiscal impact regarding the proposed rulemaking.
7. The proposed rule changes are intended to be effective upon the day after the date of publication of the adoption notice.
8. 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: Kassie Thompson, 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., September 2, 2022.
9. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
10. 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 8 above or may be made by completing a request form at any rules hearing held by the department.
11. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.
12. With regard to the requirements of 2-4-111, MCA, the department has determined that the adoption, amendment, and repeal of the above-referenced rules will not significantly and directly impact small businesses.
/s/ FLINT MURFITT /s/ CHARLES T. BRERETON Flint Murfitt Charles T. Brereton, Director Rule Reviewer Department of Public Health and Human Services
Certified to the Secretary of State July 26, 2022.
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