BEFORE THE Department of Public
health and human services of the
STATE OF MONTANA
In the matter of the amendment of ARM 37.27.902, 37.87.102, 37.87.702, and 37.88.101 pertaining to licensed marriage and family therapists and policy changes for medication assisted treatment
NOTICE OF AMENDMENT
TO: All Concerned Persons
1. On January 15, 2021, the Department of Public Health and Human Services published MAR Notice No. 37-940 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 52 of the 2021 Montana Administrative Register, Issue Number 1. On February 12, 2021, the department published an amended notice to MAR Notice No. 37-940 pertaining to the amendment of the above-stated rules at page 164 of the 2021 Montana Administrative Register, Issue Number 3.
2. The department has amended the above-stated rules as proposed.
3. Based on comments received, the department has made changes, described in the responses to the comments below, to the Addictive and Mental Disorder Division Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health, dated March 1, 2021.
4. 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: Multiple commenters expressed concern about limiting the Medication Assisted Treatment (MAT) intake rate to only once every 365 days. One commenter recommended a reduced or tiered rate for members who have discharged and later readmitted to MAT.
RESPONSE #1: The department thanks the commenter for the suggestion. The department will remove the 365-day limitation for the MAT intake rate at this time and will review this topic for a future amendment.
COMMENT #2: A commenter stated that the original Drug Addiction Treatment Act of 2000 (DATA 2000) allows referrals to behavioral health services and does not require a person to receive behavioral health services. The commenter is concerned that requiring behavioral health services would increase the dropout rate for patients. The commenter stated that clinical experience and indirect data support better long-term outcomes with behavioral health services when the patient is ready.
RESPONSE #2: The department's proposed rule amendments require a patient to be screened for behavioral health services, and a referral should occur only if the screening indicates behavioral health services are appropriate. The department is not making MAT services contingent upon the receipt of behavioral health services.
COMMENT #3: A commenter stated that the term "mental health assessment" may deter providers from getting their waivers to provide MAT services and recommends using the language "screening and integrated behavioral health assessment" as more common language in primary care.
RESPONSE #3: The department will make the requested change to the terminology for behavioral health assessments.
COMMENT #4: A commenter stated that limiting definitive testing to eight times per year is reasonable and does not interfere with the point of contact testing if applicable.
RESPONSE #4: The department thanks the commenter for their input.
COMMENT #5: A commenter expressed support for the addition of Licensed Marriage and Family Therapists to Montana Medicaid.
RESPONSE #5: The department thanks the commenter for their input.
COMMENT #6: A commenter asked for the department's intention in requiring an in-person intake into MAT services when SAMSHA allows for video or telephonic visits for assessments.
RESPONSE #6: The department will review this comment for future consideration. The department has always required "face-to-face" MAT Intake. The amendment to this language was to clarify that face-to-face meant in-person.
COMMENT #7: Multiple commenters stated disagreement with the limitation of definitive drug testing to eight times per year, suggesting that this is not best practice and that a member may need definitive testing up to four times in the first month alone. One commenter referred to a journal article, Appropriate Use of Drug Testing in Clinical Addiction Medicine published by the American Society of Addiction Medicine (http://1viuw040k2mx3a7mwz1lwva5.wpengine.netdna-cdn.com/wp-content/uploads/2017/11/appropriate_use_of_drug_testing_in_clinical-1-7.pdf).
RESPONSE #7: The department acknowledges that drug testing is an integral part of MAT services and recognizes the department's responsibility to fund clinically appropriate services in a fiscally responsible way. In response to the comments, the department will increase the number of allowable definitive tests to twelve per year and add medical necessity criteria to the manual. The department notes that the journal article cited by the commenter states, "The inappropriate use of drug testing can have extraordinary costs to third-party payers, taxpayers, and at times the patients who are receiving care."
5. The department intends to apply these rules retroactively to March 1, 2021. A retroactive application of the proposed rules does not result in a negative impact to any affected party.
/s/ Brenda K. Elias /s/ Adam Meier
Brenda K. Elias Adam Meier, Director
Rule Reviewer Public Health and Human Services
Certified to the Secretary of State March 16, 2021.