BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.87.901 and 37.87.903 pertaining to the children's mental health utilization review manual and fee schedule
NOTICE OF PROPOSED AMENDMENT
TO: All Concerned Persons
1. On December 26, 2012, at 9:00 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, Helena, Montana, to consider the proposed amendment of the above-stated rules.
2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on December 19, 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 firstname.lastname@example.org.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.87.901 MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, REIMBURSEMENT (1) Medicaid reimbursement for mental health services shall be the lowest of:
(a) remains the same.
(b) the rate established in the department's fee schedule. The department adopts and incorporates by reference the department's Medicaid Youth Mental Health Services Fee Schedule dated
July 1, 2012 January 31, 2013. A copy of the fee schedule may be obtained from the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, 111 Sanders, P.O. Box 4210, Helena, MT 59604 or at www.mt.medicaid.org.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
37.87.903 MEDICAID MENTAL HEALTH SERVICES FOR YOUTH, AUTHORIZATION REQUIREMENTS (1) through (7) remain the same.
(8) Review of authorization requests and retrospective reviews by the department or its designee will be made with consideration of the department's clinical management guidelines. The department adopts and incorporates by reference the Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management dated
October 1, 2012 January 31, 2013. 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, Developmental Services Division, Children's Mental Health Bureau, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210 or at www.dphhs.mt.gov/mentalhealth/children/index.shtml.
(9) and (10) remain the same.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, 53-6-111, MCA
4. STATEMENT OF REASONABLE NECESSITY
The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.87.901 and 37.87.903 pertaining to the children's mental health utilization review manual and fee schedule.
The department is proposing to amend ARM 37.87.901 to correct the reimbursement rate in the "Medicaid Mental Health and Mental Health Services Plan, Individuals Under 18 Years of Age Fee Schedule," dated July 1, 2012, regarding respite care. This amendment is necessary to make sure that providers have current and correct information regarding reimbursement rates available to them. This amendment does not result in a fiscal impact because it corrects the information in the fee schedule to reflect the current billable amount in the Medicaid Management Information System (MMIS) billing system.
The department is proposing to amend ARM 37.87.903 pertaining to Medicaid authorization for mental health services for youths. The Children's Mental Health Bureau (CMHB) recently completed a review of the therapeutic family care program and as a result of substantial changes to that program, including a name change, these proposed amendments are necessary to align the manual that is adopted and incorporated into this rule with the changes. CMHB is proposing to update the current provider manual, "Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management" dated October 1, 2012 and the administrative rule language. The proposed changes to ARM 37.87.903 and the "Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management" are described below. This manual can be found at the following web site: www.dphhs.mt.gov/mentalhealth/children/index.shtml. The department is proposing an effective date of January 31, 2013 for the "Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management." This is necessary in order to adopt and incorporate the revised manual into rule.
The department is proposing adoption and incorporation into rule a revised "Provider Manual for Clinical Management Guidelines" to align with administrative rule changes to therapeutic family care, including changing the program name to home support services (HSS), which is anticipated to be concurrent with this rule change.
The department is proposing to remove service definitions from the manual. This is necessary to prevent duplication with those in rule and to minimize potential discrepancies which have the potential to be confusing for providers.
The department is proposing to remove the Psychiatric Residential Treatment Facilities (PRTF) Waiver section from this manual. This is necessary because the PRTF Waiver has been replaced with the new "Bridge" Waiver. Medical necessity criteria are being added for the following services: Home Support Services (HSS); Comprehensive School and Community Treatment (CSCT); Bridge Waiver; and Montana iHome (pending). This is necessary because of changes to existing programs and the addition of two new programs. Home support services, previously known as therapeutic family care, is referenced in the manual as therapeutic family care, therefore it is necessary to update the name change. The current CSCT program moved to the Children's Mental Health Bureau (CMHB) from the Health Resources Division. As the program is now under CMHB, the medical necessity criteria needs to be added to the manual. CMHB has also added to new services, the Bridge Waiver and the Montana iHome (pending CMS approval) which are reflected in the revised manual.
The department is proposing new language for the following services: Outpatient concurrent with Therapeutic Group Home (TGH); Therapeutic Foster Care, Permanency; Community-Based Psychiatric Rehabilitation and Support (CBPRS); and The Appeal Process. The change to the language for these services is necessary to be consistent with current rule changes.
The department is also proposing to move the Medicaid Mental Health Plan and Mental Health Services Plan for Youth Services Excluded from Simultaneous Reimbursement (Service Matrix) adopted and incorporated in ARM 37.87.903 to the utilization review manual as appendix A. The department is creating a new matrix of community-based services and instructions for medical necessity documentation. This is necessary to bring current the information contained therein.
There is no expected fiscal impact as a result of these rule amendments.
5. These rule amendments are effective January 31, 2013.
6. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail email@example.com, and must be received no later than 5:00 p.m., January 3, 2013.
7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
8. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 6 above or may be made by completing a request form at any rules hearing held by the department.
9. An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.
10. The bill sponsor contact requirements of 2-4-302, MCA do not apply.
/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 26, 2012.