Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the amendment of ARM 37.87.1803, 37.106.1955, and 37.106.1961 pertaining to the removal of Montana Child and Adolescent Needs and Strengths (CANS) assessments for Mental Health Centers (MHC) involving Comprehensive School and Community Treatment (CSCT)

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

TO: All Concerned Persons

1. On July 28, 2016, at 9:00 a.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium 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 the Department of Public Health and Human Services no later than 5:00 p.m. on July 20, 2016, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

37.87.1803 COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM: REIMBURSEMENT (1) through (4) remain the same.

(5) For a youth to qualify for more than 20 units of CSCT, a full clinical assessment is required and the youth must meet the SED criteria in ARM ~~37.87.303~~ 37.87.903(8).

(6) through (8) remain the same.

(9) The school district must provide to the department:

~~(a)~~ a copy of the certification of match documentation as required by the department, annually;

~~(b) a copy of the contract for services with the mental health center, annually;~~

~~(c) updates of all information in the MMIS billing system using the form provided in the youth mental health services manual by July 15, 2013; and~~

(d) updates of all information in the MMIS billing system using the form provided in the youth mental health services manual when there is a change in contracted mental health center, location of team(s), contact information or a new team.

(10) remains the same.

(11) The school must submit to the department an annual report prepared jointly by the school and the mental health center regarding the effectiveness of the CSCT program as determined in ARM 37.106.1956(9).

AUTH: 53-2-201, 53-6-113, MCA

IMP: 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

37.106.1955 MENTAL HEALTH CENTER: COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM (CSCT) ENDORSEMENT REQUIREMENTS (1) and (2) remain the same.

(3) As of October 1, 2014, the child and adolescent needs and strengths (CANS MT) assessment must be initiated for each youth with serious emotional disturbance (SED) enrolled to receive services in the CSCT program within fourteen calendar days of receipt of a referral signed by the person referring the youth and by a parent or legal representative/guardian of the youth. The CANS MT must be:

~~(a) finalized prior to the completion of the individualized treatment plan for the youth;~~

~~(b) updated a minimum of every 90 days while the youth continues to receive CSCT services; and~~

~~(c) completed upon the discharge of the youth from the program.~~

~~(4)~~ (3) The mental health center must have a written contract with the school district in accordance with ARM 37.87.1802.

AUTH: 53-2-201, 53-6-113, MCA

IMP: 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

37.106.1961 MENTAL HEALTH CENTER: COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT (CSCT) PROGRAM, RECORD REQUIREMENTS

(1) In addition to any clinical records required in ARM 37.85.414 or elsewhere in these rules, the licensed mental health center's CSCT program must maintain the following records for youth with serious emotional disturbance (SED):

(a) a written referral cosigned by the parent(s), or legal representative/, or guardian, which documents the reason for the referral;

(b) a signed verification indicating the parent(s), or legal representative/, or guardian has been informed that Medicaid requires coordination between CSCT, home support services, and outpatient therapy;

~~(2) In addition to (1), beginning October 1, 2014, youth records must also include the child and adolescent needs and strengths (CANS MT) assessment results.~~

~~(3)~~ (2) In addition to any clinical records required in ARM 37.85.414 or elsewhere in these rules, records for youth referred to CSCT regardless of their diagnosis as described in ARM 37.87.1803(4) must include the following:

(a) a written referral, signed by the person referring the youth and by the ~~parent(s)/legal representative/guardian~~ parent(s), legal representative, or guardian, which documents the reason for the referral;

(b) and (c) remain the same.

(4) remains the same, but is renumbered (3).

AUTH: 53-2-201, 53-6-113, MCA

IMP: 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA

4. STATEMENT OF REASONABLE NECESSITY

The Department of Public Health and Human Services (department) proposes amendments to ARM 37.87.1803, 37.106.1955, and 37.106.1961 pertaining to Comprehensive School and Community Treatment (CSCT). CSCT is administered by the department and is provided by a public school district directly or through a subcontract with a mental health center (MHC). The proposed rule changes include the removal of the requirements for the Montana Child and Adolescent Needs and Strengths (CANS) assessment and the removal of the requirement for the MHC and the school to file an annual joint report.

The proposed rule amendments pertaining to CANS are necessary because an integral component of managing the CANS assessment, the Montana CANS System (MCS), was decommissioned by the department due to unresolved complications in its implementation. The MCS was to serve as the communicative tool in which providers could enter, share, store, and report on the CANS assessments. Without a fully functioning MCS, the CANS assessment cannot be used in the manner it is intended.

The proposed rule amendments to remove annual joint reports for the school and MHC are necessary because the department has determined the reporting requirement is somewhat arbitrary and, despite the department's intention of receiving comprehensive data reporting by the school and MHC, the value of the inconsistently supplied data from the joint reports is nominal.

ARM 37.87.1803

The department also proposes to remove (9)(b) through (d) because they reference a manual and a document that are no longer in use.

The department proposes to remove (11), which requires the MHC and the public school to file an annual report to the department as provided in ARM 37.106.1956(9). ARM 37.106.1956(9) required the MHC and the appropriate school district representative meet every 90 days to assess the effectiveness of the program regarding youth progress on the individual treatment plan, attendance, CSCT referrals, contacts with law enforcement, referrals to higher levels of care, and discharges from the CSCT program.

The department proposes to update the reference to ARM 37.87.303, which was repealed, and provide the correct reference to ARM 37.87.903(8) which adopts and incorporates the Children's Mental Health Bureau, Medicaid Services Provider Manual (manual). The criteria for Serious Emotional Disturbance was removed from ARM 37.87.303 and is now located in the manual.

ARM 37.106.1955

The department proposes to remove current (3), which requires the MHC to administer the CANS assessment for youth with a serious emotional disturbance who are enrolled in the CSCT program, and renumber (4) as a new (3).

ARM 37.106.1961

The department proposes to remove (2), which requires the MHC to keep a record of the results of the Montana CANS assessment in the records of the youth served in the CSCT program, and renumber current (3) and (4) as new (2) and (3). As the requirement to administer the CANS assessment is being removed in ARM 37.106.1955(3), this requirement is no longer necessary.

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., August 5, 2016.

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

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

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

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

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

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

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

/s/ Brenda K. Elias /s/ Richard H. Opper

Brenda K. Elias, Attorney Richard H. Opper, Director

Rule Reviewer Public Health and Human Services

Certified to the Secretary of State June 27, 2016.