Montana Administrative Register Notice 37-723 No. 16   08/27/2015    
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In the matter of the adoption of New Rule I pertaining to Short-Term Voluntary Inpatient Mental Health Treatment







          TO: All Concerned Persons


          1. On September 16, 2015, at 10:00 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 adoption of the above-stated rule.


          2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact the Department of Public Health and Human Services no later than 5:00 p.m. on September 9, 2015, 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 rule as proposed to be adopted provides as follows:


          NEW RULE I CONTRACTS FOR PAYMENT OF SHORT-TERM INPATIENT TREATMENT (1) The department may contract with eligible providers for payment for short-term inpatient treatment to eligible patients as provided in 53-21-1205 and 53-21-1206, MCA, to the extent of available funding.

          (2) Eligible providers include:

          (a) licensed mental health centers that operate inpatient crisis stabilization programs as defined in ARM 37.106.2027; and

          (b) hospitals with an inpatient behavioral health unit.

          (3) Documentation of services and outcomes must be provided to the department as required by contract.

          (4) Eligible patients are the subjects of civil commitment petitions under Title 53, chapter 21, part 1, MCA, for whom the following conditions are met:

          (a)  diversion to short-term inpatient treatment has been recommended by the evaluating professional person as provided in 53-21-123(2)(a), MCA;

          (b)  the facility has agreed to accept the patient for up to 14 days inpatient treatment as provided in 53-21-1205 and 53-21-1206, MCA;

          (c)  the patient has agreed to voluntary short-term inpatient treatment as provided in 53-21-1205 and 53-21-1206, MCA;

          (d) the commitment court has ordered a suspension of the civil commitment proceeding for the purpose of short-term inpatient treatment, as provided in 53-21-123(3)(b), MCA; and

          (e) no known third party has a legal liability to pay for the services provided. Third party liability is defined in ARM 37.85.407, with the exception that the Montana Medicaid program is a third party for the purposes of this rule.

          (5)  Each contract with an eligible provider must provide that reimbursement will be made for up to 14 contiguous days of inpatient care for each eligible patient, in the order in which claims from all eligible providers are received by the department until the available funding has been exhausted. The department must notify each eligible provider who has entered into a contract under this rule when the available funding has been exhausted.

          (6)  The following rates will apply:

          (a)  inpatient hospital behavioral health unit:  an all-inclusive rate of $875 per day, which includes hospitalization, professional fees, laboratory, medications, medical procedures, evaluating and assessment services, discharge planning, and therapies.

          (b)  inpatient crisis stabilization program:  an all-inclusive rate of $575 per day, which includes crisis facility stay, professional fees, medical procedures, laboratory, medications, evaluating and assessment services, case management, and therapies.

          (7) This rule is effective July 1, 2015.


AUTH: 53-21-1202, MCA

IMP: 53-21-1202, 53-21-1205, MCA




The Department of Public Health and Human Services (the department) is proposing to adopt New Rule I in order to implement the mandate of House Bill 35 (HB35) passed by the 64th Montana Legislature in 2015. House Bill 35 requires the department to "adopt rules to . . . pay for short-term inpatient treatment that is provided pursuant to 53-21-1205."  HB35 also provides an appropriation of $1,000,000 for the biennium beginning July 1, 2015, and requires that "the money must be . . . spent in accordance with rules adopted pursuant to 53-21-1202."  These rules are therefore necessary to spend the money appropriated for the purpose of HB35, which is to encourage the diversion of individuals from commitment to Montana State Hospital and other mental health facilities who would be better served in a short-term outpatient setting.


The department met with a range of providers to discuss the feasibility of the program and their ability to provide the service, and concluded that contracting with eligible providers for services to eligible patients is the most efficient method of providing this service.  This proposed rule identifies providers who may enter into contracts, describes the eligible patients for whom reimbursements may be made, and sets all-inclusive per diem rates for up to 14 days of inpatient care.


New Rule I


Proposed New Rule I defines eligible providers as inpatient behavioral health units in hospital settings and mental health centers with inpatient crisis stabilization facilities. The persons eligible to receive services are persons who are being diverted from the statutory 3-month civil commitment process to short-term inpatient treatment for up to 14 days, as provided in 53-21-1205 and 53-21-1206, MCA. The persons must be determined appropriate for the service by a professional person as provided in 53-21-123(2)(a), MCA. The commitment court must order a suspension of the civil commitment proceeding for the purpose of short-term inpatient treatment. Persons receiving this service must voluntarily agree to the short-term inpatient treatment in lieu of commitment to Montana State Hospital or another mental health facility. Eligible providers will be reimbursed through contracts with the department when the patient has no other payer source for the service.


Fiscal Impact


The fiscal impact is $500,000 general fund for fiscal year (FY) 2016 and $500,000 for FY 2017.  It is estimated the program will serve 50 persons who would otherwise be committed to the Montana State Hospital each year. It is anticipated this appropriation will continue into the next biennium.


          5. The department intends to apply this rule retroactively to July 1, 2015. A retroactive application of the proposed rule does not result in a negative impact to any affected party.


          6. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., September 24, 2015.


          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, apply and have been fulfilled. The primary bill sponsor was notified by e-mail on August 27, 2015.


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


          12. 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.


The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.



/s/ Paulette Kohman                              /s/ Richard H. Opper                            

Paulette Kohman, Attorney                    Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services



Certified to the Secretary of State August 17, 2014.



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