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Montana Administrative Register Notice 37-613 No. 22   11/23/2012    
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BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the adoption New Rules I through VI pertaining to targeted case management services for substance use disorders

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION

 

TO:  All Concerned Persons

 

            1.  On December 13, 2012, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, at Helena, Montana, to consider the proposed adoption of the above-stated rules.

 

2.  The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice.  If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on December 6, 2012, to advise us of the nature of the accommodation that you need.  Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

3.  The rules as proposed to be adopted provide as follows:

 

NEW RULE I  TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, DEFINITIONS  (1)  "Adult" means a person 21 years of age or older.

(2)  "Assessment" and "periodic reassessment" means determining the need for any medical, educational, social, or other services.  These assessment activities include the following:

(a)  taking client history;

(b)  identifying the needs of the individual and completing related documentation;

(c)  gathering information from other sources, such as family members, medical providers, social workers, and educators (if necessary) to form a complete assessment of the eligible individual.

(3)  "Case Planning" means the development and periodic revision of a specific care plan based on the information collected through the assessment, that includes the following:

(a)  specifies the goals and actions to address the medical, social, education, and other services needed by the eligible individual.

(b)  includes activities such as ensuring the active participation of the eligible individual and working with the individual, the individual's authorized health care decision maker, if appropriate, or others to develop those goals.

(c)  identifies a course of action to respond to the assessed needs of the eligible individual.

(4)  "Coordination, referral, and related activities" means activities that help the eligible individual obtain needed services. The activities include ones that help link the individual with medical, social, and educational providers or other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the care plan.

(5)  "Monitoring and follow-up activities" means activities and contacts necessary to ensure the care plan is effectively implemented and adequately addresses the needs of the eligible individual.  These activities may be with the person, family members, service providers, or other entities or individuals and conducted as frequently as necessary to help determine whether the following conditions have occurred:

(a)  services are being furnished in accordance with the person's care plan;

(b)  services in the care plan are adequate to meet the needs of the person; or

(c)  change(s) occurred in the needs or status of the person.

(6)  "SSA" means Social Security Act.

(7)  "Substance Abuse" means a person meets requirements in DSM-IV-TR for diagnosis of: 305.00; 305.20; 305.30; 305.40; 305.50; 305.60; 305.70; or 305.90.

(8)  "Substance Dependency" means a person meets requirements in DSM-IV-TR for diagnosis of: 303.90; 304.20; 304.30; 304.40; 304.60; 304.70; 304.80; 305.50; or 307.90.

(9)  "Substance Use Disorders" means a person who has either a diagnosis of substance abuse and/or substance dependency.

(10)  "TCM" means Targeted Case Management.

(11)  "Youth" means a person from birth up to and including 20 years of age.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-113, MCA

 

NEW RULE II  TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, ELIGIBILITY  (1)  TCM services are available under [New Rule I through VI] only to persons  who meet the following criteria:

(a)  Youth who are 20 years of age or younger with a diagnosis of substance dependency or substance abuse.

(b)  Adults who are 21 years of age or older with a diagnosis of substance dependency.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-113, MCA

 

NEW RULE III  TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, SERVICE COVERAGE  (1)  TCM services must meet all requirements found in ARM 37.86.3301 through 37.86.3306.

(2)  TCM services for substance use disorders include those indicated in [New Rule I] (2) through (5).

            (3)  TCM services for substance use disorders are provided by state-approved chemical dependency treatment programs in accordance with these rules and the provisions of ARM 37.27.901 through ARM 37.27.912, and 53-24-208, MCA.

(4)  TCM services may include contacts with noneligible individuals for purposes related to identification of the person's needs, accessing needed services, identifying needs and supports to assist in obtaining identified services, providing case managers with useful feedback, and alerting case managers to changes in the person's needs.

(5)  TCM does not include:

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

(b)  when activities are an integral and inseparable component of another covered Medicaid service;

(c)  duplicate payments made to public agencies or private entities under the State Plan and other program authorities;

(d)  writing, recording, or entering case notes for the person's file;

(e) coordination of the investigation of suspected abuse, neglect, and/or exploitation cases;

(f)  travel to and from activities, with or without the person;

(g)  any service that does not incorporate the allowable TCM components, even if written into the individualized TCM case plan;

(h)  Medicaid determination and redetermination (arranging for appointments, monitoring completion of needed steps for determination are eligible TCM services); and

(i)  activities for which a person may be eligible that are integral to the administration of another nonmedical program such as guardianship, child welfare/child protective services, parole, probation, foster care services, or specialized education programs except for case management that is included in an individualized education program or individualized family service plan consistent with SSA section 1903c for services furnished to a child with a disability or to an infant or toddler with a disability.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-113, MCA

 

NEW RULE IV  TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, SERVICE REQUIREMENTS  (1)  Persons receiving TCM services are allowed the freedom of choice of any qualified Medicaid provider for targeted case management services.

(2)  TCM service providers cannot restrict a person's access to other Medicaid services.

(3)  TCM services will not duplicate payments made to public agencies or private entities under the Medicaid program and other program authorities.

(4)  A person cannot be compelled to receive TCM services as a condition of receipt of other Medicaid services or condition receipt of other Medicaid services on receipt of TCM services.

(5)  TCM services must be supported by narrative documentation of all services provided.

(6)  TCM services must be provided according to a TCM plan which must:

            (a)  be developed jointly by the case manager and the person;

            (b)  identify measurable objectives;

            (c)  specify strategies to achieve defined objectives;

            (d)  identify agencies and contacts which will assist in meeting the objectives;

            (e)  be incorporated into the treatment plan;

(f)  identify natural and community supports to be utilized and developed; and

            (g)  include an objective to serve the person in the least restrictive and most culturally appropriate therapeutic environment possible for the person.  The TCM plan should also be directed toward facilitating preservation of the person in the family unit, preventing out-of-community placement, or facilitating the person's return from inpatient or residential care.

(7)  Objectives in a TCM plan must have an identified date of review no more than 90 days after the plan date.  Plans will be revised to reflect changes in personal goals and needs, and services provided to the person.

(8)  TCM services must be delivered in accordance with the person's needs.

(9)  Comprehensive TCM services must be provided on a one-to-one basis, to one person, and through one case manager.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-113, MCA

 

NEW RULE V  TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, PROVIDER REQUIREMENTS  (1)  The requirement in (2) is in addition to those requirements contained in rules generally applicable to Medicaid providers.

            (2)  TCM services for substance use disorders must be provided by a state-approved substance use disorder treatment program that is enrolled in the Montana Medicaid program.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-113, MCA

 

NEW RULE VI  TARGETED CASE MANAGEMENT SERVICES FOR SUBSTANCE USE DISORDERS, REIMBURSEMENT  (1)  TCM services for substance use disorders will be reimbursed on a fee per unit of service basis.  For purposes of this rule, a unit of service is a period of 15 minutes.

(2)  The department may, in its discretion, designate a single provider to provide targeted case management services in a designated geographical region.  Any provider designated as the sole case management provider for a designated geographical region must, as a condition of such designation, agree to serve the entire designated geographical region.

(3)  The department will pay the lower of the following for TCM services:

            (a)  the provider's actual submitted charge for services; or

            (b)  the amount specified in the State Approved Chemical Dependency Program Manual.

(4)  Providers may bill TCM services for persons transitioning from an institution to a community setting as follows:

            (a)  With a covered inpatient stay, the person receiving services may be eligible for TCM services during the last 14 days prior to discharge to the community.

(b)  TCM activities must be coordinated with and not duplicate inpatient discharge planning.

(c)  Amount, duration, and scope of the case management activities will be documented in a person's plan of care including activities prior to and post-discharge, to facilitate a successful transition to community living.

 

AUTH:  53-2-201, 53-6-113, MCA

IMP:     53-2-201, 53-6-101, 53-6-113, MCA

 

            4.  STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (department) is proposing to adopt New Rules I through VI to implement Medicaid Targeted Case Management for adults diagnosed with a substance use disorder dependency or youth diagnosed with substance use disorder abuse or dependency.

 

The Montana Medicaid program is administered by the department to provide health care to Montana's qualified low income and disabled residents.  In order to provide health care services to these Montana residents, services need to be defined, limitations or qualifications provided, and requirements outlined.  These rules are necessary to specify eligibility, service coverage, provider requirements, and reimbursement for Medicaid targeted case management services for substance use disorders.

 

The department is seeking federal matching funds through the Medicaid program.  In order to provide targeted case management services to a specific population such as an individual with a substance use disorder, the department must provide a rule structure to ensure federal regulations governing targeted case management is in place.  The structure needs to include:  defining terms; stating who is eligible to receive such services; what type of service can and cannot be provided; conditions and documentation is required to justify or satisfy the service meets criteria; who can provide services; and how services will be reimbursed.

 

The approaches taken for writing these proposed rules are as follows:

 

1.         The current code of federal regulations was reviewed.

 

2.         Current administrative rules governing all Medicaid targeted case management were requested and reviewed.

 

3.         Program personnel from other Medicaid targeted case management programs were informed of these proposed rules.

 

4.         A Chemical Dependency Bureau focus group made up of six state-approved chemical dependency program providers including one urban provider; three urban/frontier providers; one frontier provider; and one Native American program provider; was convened to discuss criteria required for Medicaid funding, current regulations, and allow discussion and provider input.

 

5.         Draft rules were written and sent via e-mail to the focus group for further input, comments, and corrections.

 

6.         One telephone conference call was completed to allow discussion.

 

7.         The final draft of the rule was e-mailed to the focus group allowing them one last opportunity to provide comment or input prior to filing.

 

New Rule I

 

This rule is necessary to define the terms used in Medicaid targeted case management services for substance use disorders.

 

New Rule II

 

This rule is necessary to state client eligibility requirements and to define the specific population for Medicaid targeted case management services for substance use disorders.

 

New Rule III

 

This rule is necessary to define what Medicaid targeted case management services for substance use disorders includes and does not include.

 

New Rule IV

 

This rule is necessary to state the criteria for client participation and documentation of Medicaid targeted case management services for substance use disorders.

 

New Rule V

 

This rule is necessary to state the provider requirements to participate in Medicaid targeted case management services for substance use disorders. 

 

New Rule VI

 

This rule is necessary to state the criteria by which reimbursement can be made for Medicaid targeted case management services for substance use disorders.

 

            5.  Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing.  Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., December 21, 2012.

 

6.  The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

7.  The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices.  Notices will be sent by e-mail unless a mailing preference is noted in the request.  Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.

 

8.  An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.

 

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

 

 

 

/s/ John Koch                                               /s/ Anna Whiting Sorrell                            

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                      Public Health and Human Services

           

Certified to the Secretary of State November 13, 2012.

 

 

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