BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.87.1410 pertaining to specifying the location of minimum scheduled face-to-face contacts within a home and community environment
NOTICE OF AMENDMENT
TO: All Concerned Persons
1. On February 17, 2017, the Department of Public Health and Human Services published MAR Notice No. 37-784 pertaining to the public hearing on the proposed amendment of the above-stated rule at page 217 of the 2017 Montana Administrative Register, Issue Number 4.
2. The department has amended the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:
37.87.1410 HOME SUPPORT SERVICES (HSS) AND THERAPEUTIC FOSTER CARE (TFC), PROVIDER REQUIREMENTS (1) through (5) remain as proposed.
(6) The following requirements must be met by either the clinical lead, the HSS-S, or both:
(a) remains as proposed.
(b) conduct a minimum of four scheduled contacts or sessions with the caregiver in each four-week period, two of which must be face-to-face within the home and community environment, excluding
an the provider's office or facility, based on the needs of the caregiver and documented in the ITP;
(c) conduct a minimum of two scheduled face-to-face treatment sessions within the home and community environment, excluding
an the provider's office or facility, with the youth in each four-week period, based on the needs of the youth and documented in the ITP; and
(d) services provided above the minimum face-to-face contact requirements in (b) and (c) may be provided in
an the provider's office or facility to further meet the identified needs of the youth and the caregiver documented in the ITP. The duration of the contacts are not limited.
(7) and (8) remain as proposed.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-2-201, 53-6-101, MCA
3. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:
COMMENT #1: One commenter stated that it would be appropriate for each agency's licensed clinical staff supervising the home support specialist to assist in determining the appropriate setting for weekly contacts rather than following a sterile rule that may not fit all situations or allow for family voice and choice.
RESPONSE #1: As defined in ARM 37.87.1402, Home Support Services are medically necessary, intensive in-home services delivered by providers with specialized training and experience working with caregivers and youth in their homes. The parent/caregiver agrees to in-home support services to strengthen their capacity to support the youth effectively and improve the functioning of the youth as evidenced by a signature from the youth, if appropriate, and caregiver on the individualized treatment plan. The home support specialist or licensed clinical staff has flexibility in determining the appropriate setting for the minimum face-to-face contacts with the proposed rule amendment.
COMMENT #2: One commenter asked what is meant by "It has been brought to our attention there is confusion regarding the location in which the minimum face-to-face contacts may be held."
RESPONSE #2: The intent of the rulemaking is to clarify that the minimum face-to-face contacts, defined in ARM 37.87.1410, must be in the home or community. The youth and parent/caregiver require more intensive therapeutic interventions than are available through other outpatient services. The provider's office or facility is not considered the community for the purpose of the minimum contacts.
COMMENT #3: One commenter asked what constitutes an agency office. Can weekly contacts be facilitated in the Department of Family Services (DFS) office? Are DFS offices considered agency offices or community settings? Home Support Services is a quality service available to families when children have been removed and are in the process of reunification. DFS facilities may be the best location to meet for all parties in these situations.
RESPONSE #3: The department appreciates the comment and agrees. The department has amended the proposed rule in (6) by adding the word "provider's," which clarifies it is the provider's office or facility that is being excluded.
COMMENT #4: One commenter asked how amending this rule improves outcomes or treatment of Home Support Services clients.
RESPONSE #4: The proposed rulemaking refers to the minimum required face-to-face contacts. Home Support Services requires a structured, consistent, strength-based therapeutic relationship between the provider and the youth and parent/caregiver for the purpose of treating the behavioral health needs of the youth, including improving the caregiver's ability to provide effective support for the youth and to promote healthy functioning. To receive this service, symptoms of the serious emotional disturbance of the youth must be of a persistent nature requiring in-home behavioral intervention.
COMMENT #5: Two commenters asked how an agency handles situations where a family requests to have weekly contacts in the agency’s office due to convenience or privacy. Would they be denied services?
RESPONSE #5: Home Support Services admission criteria require the parent/caregiver agrees to in-home support services with the flexibility of the community environment. Face-to-face contacts over and above the minimum requirement may be in the provider's office or facility.
COMMENT #6: Two commenters stated occasional situations where the family home presents safety concerns for the provider such as extraordinarily unsanitary living conditions, illicit drug use, multiple unrelated individuals present in the home, or inaccessible roads due to inclement weather. The commenter requests exceptions are required to be clearly documented for justification upon retrospective review.
RESPONSE #6: The focus of this rulemaking is the minimum required face-to-face contacts. Contacts over and above the minimum requirement may be in the provider's office or facility. Home Support Services helps parents develop the skills and tools to manage their child's behaviors in the home. Safety concerns are addressed in the benefit exclusion criteria when the home environment presents a serious safety risk to the staff persons providing the service.
COMMENT #7: One commenter stated it is unusual for the Home Support Services benefit exclusion criteria to include the safety risk to the staff persons providing the service. In the case of a serious safety risk, would the department determine the provider is not allowed to provide Home Support Services? The commenter recommends the safety criteria be removed from the benefit exclusion criteria.
RESPONSE #7: This comment is outside the scope of the proposed rulemaking.
/s/ Jorge Quintana /s/ Sheila Hogan
Jorge Quintana, Attorney Sheila Hogan, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State May 1, 2017.