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Montana Administrative Register Notice 37-519 No. 18   09/23/2010    
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                                                 BEFORE THE DEPARTMENT OF PUBLIC

                                                HEALTH AND HUMAN SERVICES OF THE

                                                                  STATE OF MONTANA

 

In the matter of the adoption of New Rules I through XLII, the amendment of ARM 37.97.101, 37.97.102, 37.97.105, 37.97.106, 37.97.110, 37.97.115, 37.97.128, 37.97.130, 37.97.132, 37.97.206, 37.97.207, 37.97.216, 37.97.230, and the repeal of ARM 37.97.118, 37.97.201, 37.97.202, 37.97.213, 37.97.220, 37.97.225, 37.97.226, 37.97.233, 37.97.238, 37.97.239, 37.97.250, 37.97.253, 37.97.254, 37.97.257, 37.97.258, 37.97.259, 37.97.270, 37.97.501, 37.97.502, 37.97.506, 37.97.508, 37.97.519, 37.97.521, 37.97. 522, 37.97.524, 37.97.526, 37.97.528, 37.97.801, 37.97.805, 37.97.809, 37.97.810, 37.97.811, 37.97.815, 37.97.816, 37.97.817, 37.97.820, 37.97.821, 37.97.822, 37.97.825, 37.97.830, 37.97.831, 37.97.832, 37.97.833, 37.97.836, 37.97.837, 37.97.838, 37.97.842, and 37.97.843 pertaining to youth care facility (YCF) licensure

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION, AMENDMENT, AND REPEAL

 

TO:  All Concerned Persons

 

            1.  On November 3, 2010, at 10:30 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 adoption, amendment, and repeal 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 October 25, 2010, to advise us of the nature of the accommodation that you need.  Please contact Rhonda Lesofski, 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 adopted provide as follows:

 

            NEW RULE I  YOUTH CARE FACILITY (YCF):  QUALITY ASSESSMENT

            (1)  The youth care facility (YCF) shall implement and maintain an active quality assessment program for improving policies, procedures, and services.  At a minimum, the quality assessment program must include procedures for:

            (a)  conducting youth satisfaction surveys at least annually which are maintained and filed at the facility;

            (b)  maintaining records on the occurrence, duration, and frequency of physical escorts and physical restraints used; and

            (c)  reviewing, on an ongoing basis, serious incident reports, grievances, complaints, medication errors, and the use of physical restraints with special attention given to identifying patterns and making necessary changes in how services are provided.

            (2)  The YCF shall prepare and maintain on file an annual report including improvements made as a result of the quality assessment activities specified in this rule.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE II  YOUTH CARE FACILITY (YCF):  CHILD ABUSE OR NEGLECT AND SERIOUS INCIDENTS  (1)  Each YCF shall require each staff member, employee, intern, and volunteer to read and sign a statement that clearly defines child abuse and neglect and outlines the individual's responsibility to report all known or suspected incidents of child abuse or neglect of any youth to the department within 24 hours.

            (2)  Any YCF staff member or employee who knows or has reasonable cause to suspect that an incident of child abuse or neglect has occurred shall report within 24 hours of the incident to the YCF administrator, or a person designated by the YCF administrator, and to the state child abuse hotline (866) 820-5437 as required in 41-3-201, MCA.  The YCF shall fully cooperate with any investigation conducted as a result of the report.

            (3)  A therapeutic group home must report abuse or neglect to the Mental Disabilities Board of Visitors as required in 53-21-107, MCA.

            (4)  Each YCF shall have written policies and procedures for handling any suspected incident of child abuse or neglect, including but not limited to:

            (a)  a procedure for ensuring that the staff member suspected does not continue to provide direct care until an investigation is completed;

            (b)  a procedure for developing a safety plan approved by the department which protects the youth and staff until the investigation is complete;

            (c)  a procedure for taking appropriate disciplinary measures against any staff member involved in an incident of child abuse or neglect, including but not limited to:

            (i)  termination of employment;

            (ii)  retraining of the staff member; or

            (iii)  any other appropriate action by the YCF geared towards the prevention of future incidents of child abuse or neglect.

            (5)  Any serious incident involving a youth must be reported in writing the next business day to the person or agency which placed the youth and to the department's licensure bureau.

            (a)  The report must be in writing and must include but is not limited to:

            (i)  the date and time of the incident;

            (ii)  all youth and staff member(s) involved; and

            (iii)  a description of the incident and the circumstances surrounding it.

            (b)  A copy of the report must be maintained at the YCF.

            (6)  The YCF shall cooperate with all licensing investigations, which may include private one-on-one interviews with staff and residents.

 

AUTH:  52-2-603, 52-2-622, MCA

IMP:  41-3-201, 52-2-603, 52-2-622, MCA

 

            NEW RULE III  YOUTH CARE FACILITY (YCF):  STAFF BACKGROUND CHECKS  (1)  The administrator, staff, volunteers, and interns must have a state criminal background check, a state child protective services background check, and if applicable, a tribal criminal background check and tribal child protective services background check conducted prior to being employed by the provider or working at the YCF.

            (2)  If an applicant has lived outside the state within the past five years, the YCF must complete background checks in every state that the applicant has resided in within the past five years.

            (3)  The department will deny or revoke a license upon finding that:

            (a)  the administrator, staff member, volunteer, or intern has been convicted by a court of competent jurisdiction of a felony or misdemeanor involving but not limited to homicide, sexual intercourse without consent, sexual assault, aggravated assault, assault on a minor, assault on an officer, assault with a weapon, kidnapping, aggravated kidnapping, prostitution, robbery, or burglary;

            (b)  the administrator, staff member, volunteer, or intern has a conviction for a crime pertaining to children and families, including but not limited to child abuse or neglect, incest, child sexual abuse, ritual abuse of a minor, felony partner and family member assault, child pornography, child prostitution, internet crimes involving children, felony endangering the welfare of a minor, felony unlawful transactions with children, or aggravated interference with parent-child contact;

            (c)  the administrator, staff member, volunteer, or intern has within the previous five years a felony conviction of a drug related offense, including but not limited to use, distribution, or possession of controlled substances, criminal possession of precursors to dangerous drugs, criminal manufacture of dangerous drugs, criminal possession of imitation dangerous drugs with the purpose to distribute, criminal possession, manufacture of or delivery of drug paraphernalia, or driving under the influence of alcohol or other drugs; or

            (d)  the administrator, staff member, volunteer, or intern has been convicted of abuse, sexual abuse, neglect, or exploitation of an elderly person or a person with a developmental disability.

            (4)  The department may deny or revoke a license upon finding that:

            (a)  the administrator, staff member, volunteer, or intern has a conviction for a misdemeanor partner and family member assault, misdemeanor endangering the welfare of a child, misdemeanor unlawful transaction with a child, or a crime involving an abuse of the public trust.

            (5)  The administrator, staff member, volunteer, or intern who is charged with a crime involving children, physical or sexual violence against any person, or any felony drug related offense and awaiting trial may not provide care or be present in the facility pending the outcome of the criminal proceeding.

            (6)  No administrator, staff member, volunteer, or intern shall have been named as a perpetrator in a substantiated report of child abuse or neglect.

            (7)  The YCF is responsible for assuring that the persons covered by this chapter have met these requirements before providing care.

            (8)  No administrator, staff member, volunteer, or intern shall pose any potential threat to the health, safety, and well being of the youth in care.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE IV  YOUTH CARE FACILITY (YCF):  YOUTH TO AWAKE STAFF RATIOS  (1)  The following ratio must be followed:

            (a)  the youth to awake staff ratio of a youth group home shall be no more than 8:1 at all times; and

            (b)  the youth to awake staff ratio of a youth shelter care facility shall be no more than 8:1 at all times.

            (2)  Child care agencies shall meet staffing requirements as set forth in ARM 37.97.207.

            (3)  Therapeutic group homes shall meet staffing requirements as set forth in [NEW RULE XXXIX].

            (4)  The YCF must have a policy that specifies a nighttime safety protocol for youth.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622 , MCA

 

            NEW RULE V  YOUTH CARE FACILITY (YCF):  STAFF TRAINING  (1)  A YCF shall have written policies, procedures, and initial and ongoing training curriculum that meet the minimum requirements in this rule.

            (2)  Providers shall assure adequate and timely training to ensure the safety of youth in care.

            (3)  All direct care staff shall complete a minimum of 24 hours of orientation training consisting of the following minimum requirements:

            (a)  an overview of the YCF's policy, procedures, organization, and services;

            (b)  mandatory child abuse reporting laws;

            (c)  behavioral management techniques;

            (d)  fire safety, including emergency evacuation routes;

            (e)  confidentiality;

            (f)  suicide prevention;

            (g)  emergency medical procedures;

            (h)  report writing including the development and maintenance of logs and journals;

            (i)  youth rights as outlined in [NEW RULE VI]; and

            (j)  hours required for on the job training.

            (4)  Orientation training shall be completed and documented before the staff person may count in the youth to awake staff ratio as specified in [NEW RULES IV and XXXIX].

            (5)  All direct care staff shall complete the following certification training within 90 days of hire:

            (a)  the use of de-escalation training and methods of managing youth as described in the provider's policies;

            (b)  first aid and CPR; and

            (c)  maintain and update these certifications as required.

            (6)  Direct care staff may not work alone without completing the training requirements of (5).

            (7)  The YCF shall provide ongoing training for staff to improve proficiency in their knowledge and skills.  Training must be a minimum of 20 hours annually thereafter and appropriate for the level of care provided.

            (8)  All training must be documented and kept on file for each staff member, administrator, volunteer, and intern.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE VI  YOUTH CARE FACILITY (YCF):  YOUTH RIGHTS  (1)  A YCF shall develop and maintain a youth's rights policy that supports and protects the fundamental human, civil, constitutional, and statutory rights of all youth.  These rights shall include but are not limited to the following:

            (a)  freedom from abuse, neglect, and unnecessary physical restraint;

            (b)  educational services in accordance with Montana state law, if the YCF operates during the school year;

            (c)  recognition and respect in the delivery of services;

            (d)  receive care according to individual need;

            (e)  personal privacy, when it is not contrary to the treatment and safety of the youth;

            (f)  family contact by mail and phone, as long as the contact is not contrary to the treatment and safety needs of the youth; and

            (g)  consideration of the youth's opinions and recommendations when developing the youth's case plan with documentation of the youth's input.

            (2)  The YCF shall have a youth grievance policy and procedures.

            (3)  The program shall review the youth's rights policy with the youth at the time of admission.  The youth and staff reviewing the policy shall sign a statement acknowledging the review.  The statement must be maintained in the youth's record.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE VII  YOUTH CARE FACILITY (YCF):  ADMISSIONS  (1)  Each YCF shall admit only those youth for whom it has an operational program and who meet its admissions policies.

            (2)  Each YCF shall have a policy for screening all referrals.  This policy must include procedures for accepting emergency placements.

            (3)  Each YCF shall have and follow written admissions policies and procedures which include but are not limited to the following requirements:

            (a)  age, sex, and behavioral and/or emotional needs of youth served;

            (b)  a description of the intake process for youth at admission; and

            (c)  a description of the orientation provided to the youth.

            (4)  An initial assessment of the youth's emotional, medical, developmental, social, and behavioral status must be conducted within eight hours of the youth's admission.

            (5)  The admission person or committee shall review all preplacement referral information including a social history and resources to determine the appropriateness of placement, including age and developmental needs of youth accepted into the YCF.

            (6)  The YCF's policies and procedures must provide for and encourage a preplacement process with the child and family and may allow exceptions for emergency placements and geographical distances.  The referring parties should be encouraged to assist with these arrangements.

            (7)  Placements may only be accepted from parents or agencies authorized by law to place children.

            (8)  The admissions policy may not limit contact with the youth's approved family members.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE VIII  YOUTH CARE FACILITY (YCF):  PLACEMENT AGREEMENTS  (1)  When a youth is admitted to a YCF, the YCF shall enter into a written placement agreement with the placing agency and/or parents or guardian, except when the facility has an existing written agreement with the placing agency that meets the requirements in (2).

            (2)  The placement agreement must contains the terms of the youth's placement, the responsibilities of the YCF, the placing agency's responsibilities, and when appropriate, the parent's or guardian's responsibilities.

            (3)  No youth from out of state shall be accepted into the YCF without the approval of the interstate compact administrator pursuant to Title 41, chapter 4, part 1, MCA.

            (4)  Placement agreements do not expressly or implicitly modify or supersede any other agreement between the provider and the department, and are not sufficient as written agreements to modify any other agreement between the provider and the department.  All modifications of those other agreements must be in writing.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE IX  YOUTH CARE FACILITY (YCF):  YOUTH ORIENTATION

            (1)  A YCF shall have written orientation policies and procedures for admission to the YCF.  A youth's orientation shall include but is not limited to:

            (a)  a procedure for ensuring that each youth receives a personal orientation to the YCF as soon as appropriate, but not later than 12 hours after admission;

            (b)  inventory of each youth's belongings;

            (c)  behavioral expectations;

            (d)  information on privilege systems;

            (e)  discipline policy;

            (f)  health and safety procedures;

            (g)  YCF rules;

            (h)  information on the YCF's search policies; and

            (i)  emergency evacuation procedures, including escape routes.

            (2)  Documentation that is signed by both the youth and the staff person(s) conducting the orientation must be placed in the youth's file.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

NEW RULE X  YOUTH CARE FACILITY (YCF):  CASE PLAN  (1)  Each YCF shall develop a case plan for each youth in care.  A case plan is a specific plan for providing care, treatment, and services of any kind to a specific youth.

            (2)  The case plan must include but is not limited to the following:

            (a)  the youth's physical and medical needs;

            (b)  behavior management issues;

            (c)  mental health services when appropriate;

            (d)  the service goals with corresponding time frames, placement goals, discharge plans, estimated discharge date, and follow-up services;

            (e)  education plans;

            (f)  measurable goals and objectives; and

            (g)  the responsibilities of the youth, staff, and custodial parent or guardian for meeting the goals and objectives.

            (3)  The initial case plan must:

            (a)  be developed within seven days after admission; and

            (b)  be updated at least every 90 days from the day of development.

            (4)  The placing agency, parent or guardian, and the youth must be involved in developing the case plan.

            (5)  A copy of the signed case plan must be provided to the placing agency and parent or guardian within seven days of developing and updating the plan.

            (6)  In addition to the requirements of this rule, therapeutic group homes must also meet the treatment plan requirements in [NEW RULE XLII].

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XI  YOUTH CARE FACILITY (YCF):  PHYSICAL CARE

            (1)  Every youth shall have access to the services of at least one licensed health care professional as defined in 50-5-101, MCA.

            (2)  Medical, dental, psychiatric, psychological care, and counseling services must be obtained for youth as needed.

            (3)  If a youth has not received a complete physical examination within six months prior to placement, the YCF shall arrange for the youth to have a complete physical examination within 30 days after admission to the facility and annually thereafter.

            (4)  If a youth has not had a dental examination within a year prior to placement, the YCF shall arrange for the youth to have a dental examination within 90 days after admission.  All necessary dental work must be done and checkups must be arranged for the youth at least annually.

            (5)  If a youth has not had an eye examination within a year prior to placement, the YCF shall arrange for the youth to have an eye examination within 90 days after admission.  All necessary checkups must be arranged for the youth at least annually.

            (6)  Provisions for treatment of diseases, remedial defects or deformities, and malnutrition must be made by the provider immediately upon the licensed health care professional's recommendation with notification to the placing agency and parent or guardian.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XII  YOUTH CARE FACILITY (YCF):  MEDICATION STORAGE AND ADMINISTRATION  (1)  A YCF shall have and follow written policies and procedures regarding the storage, administration, and disposal of prescription, nonprescription, and over-the-counter medication.

            (2)  All medication must be kept in a locked nonportable container, stored in its original container with the original prescription label.  For medications taken on outings, all medication must be in the possession of a staff member trained to assist with the self-administration of medications.

            (3)  Staff who assist with self-administration must be trained to assist in proper medication procedures.  Training must be documented in each staff member's personnel file.

            (4)  All prescription medications must be ordered by licensed health care professionals working within the scope of their practice.  All prescription orders must contain the dosage to be given.

            (5)  Psychotropic medication is prohibited unless a licensed health care professional working within the scope of that professional's practice determines that the medications are clinically indicated.

            (6)  Under no circumstances may psychotropic or any other prescription or over-the-counter medication be given for disciplinary purposes, for the convenience of the staff, or as a substitute for other appropriate treatment services.

            (7)  A written record of all medications self-administered by a youth must be maintained.  The record must include but is not limited to:

            (a)  youth's name;

            (b)  name and dosage of the medication;

            (c)  the date and time the medication was taken or was refused by the youth;

            (d)  name of the staff member who assisted in the self-administration of the medication; and

            (e)  documentation of any medication errors, results of errors, and any effects observed.

            (8)  Prescribed medication may not be stopped or changed in dosage or administration without first consulting with a licensed health care professional.  Results of the consultation must be recorded in the youth's record.  The licensed health care professional shall document in writing any changes to medication.  This documentation must be kept as part of the youth's case record.

            (9)  Placing workers, parents, or custodial guardians must be notified of all medications prescribed to youth including medication changes.

            (10)  All unused and expired medication must be properly disposed of and documented in the youth's case record.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XIII  YOUTH CARE FACILITY (YCF):  CARE AND GUIDANCE

            (1)  A YCF shall provide to each youth sufficient staff to ensure:

            (a)  appropriate care, supervision, safety, treatment, and guidance;

            (b)  opportunities for educational, social, and cultural growth through suitable reading materials, toys, activities, and equipment; and

            (c)  opportunities to associate with peer groups in school and community settings.

            (2)  A YCF shall ensure cooperation with the placing agency in:

            (a)  participation in case conferences; and

            (b)  arranging for contact with each youth's family unless there are documented safety reasons for restricting contact.

            (3)  When the placement has been made by the parent, the provider shall be responsible for assisting with referral for support services.

            (4)  The provider shall assist the youth and, when appropriate, the youth's family in preparing for the youth's discharge from the YCF.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XIV  YOUTH CARE FACILITY (YCF):  NUTRITION  (1)  A YCF shall provide for or serve three regular, well-balanced meals per day, and snacks.  The meals and snacks must be appropriate to the nutritional needs of the youth and must include the four basic food group requirements.

            (2)  Special diets must be provided for youth as ordered in writing by a licensed health care professional.  Such orders must be kept on file by the YCF.

            (3)  Copies of menus of the food actually served must be kept on file for one month and be available for inspection.

            (4)  All food must be transported, stored, covered, prepared, and served in a sanitary manner.

            (5)  Use of home canned products is prohibited unless the product has been commercially approved.

            (6)  Hands must be washed with warm water and soap before the handling of food.  Hand sanitizer gels may be used in lieu of washing hands with soap and water.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XV  YOUTH CARE FACILITY (YCF):  RELIGION AND CULTURE  (1)  The YCF shall have written policies and procedures on how the youth's individual religious and cultural beliefs will be addressed.

            (2)  The YCF shall provide youth with a reasonable opportunity to practice their respective religions.  Youth must be permitted to have reasonable access to religious materials of their choice.  If reasonable access is denied, the YCF must have documentation of the specific reasons for the denial.

            (3)  The YCF shall document its efforts in providing opportunity and encouragement to each youth to identify with the youth's cultural heritage.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XVI  YOUTH CARE FACILITY (YCF):  PERSONAL NEEDS

            (1)  The YCF shall assure that each youth has clothing suitable to the youth's age and size and comparable to the clothing of other youth in the community.

            (2)  Youth shall have some choice in the selection of their clothing.

            (3)  A YCF shall provide necessary supplies and train youth in personal care, hygiene, and grooming.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XVII  YOUTH CARE FACILITY (YCF):  PRIVACY AND INDIVIDUALISM  (1)  A YCF shall allow youth to have privacy.

            (2)  A YCF shall provide a separate bed, separate storage space for clothing and personal articles, and a place for each youth to display socially appropriate creative works and symbols of the youth's identity.

            (3)  Each youth must be provided with access to a quiet area where the youth can be alone when appropriate.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XVIII  YOUTH CARE FACILITY (YCF):  MONEY  (1)  Money earned by a youth or received as a gift or allowance must be part of the youth's personal property and accounted for separately from the YCF funds.

            (2)  If the YCF is partly supported by institutional production on a commercial basis, the YCF shall comply with state and federal child labor and minimum wage laws.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XIX  YOUTH CARE FACILITY (YCF):  YOUTH TRAINING AND EMPLOYMENT  (1)  For youth age 16 and older a YCF may assist in:

            (a)  preparing youth for economic independence;

            (b)  referring youth to the appropriate independent living program; and

            (c)  opportunity to obtain the skills necessary for employment as determined to be appropriate to meet the individual's needs.  Such skills include but are not limited to:

            (i)  completing applications;

            (ii)  personal appearances for employment situations;

            (iii)  attitudes toward employment; and

            (iv)  interviewing for jobs.

            (2)  A YCF shall distinguish between tasks which youth are expected to perform as part of living together, jobs to earn spending money, and jobs performed for vocational training.  Youth in care may not be used as employees of the YCF without prior approval of the department.

            (3)  Youth may be given age appropriate, nonvocational work assignments within the youth's capabilities as a constructive experience.  The work assignment shall comply with all state and federal labor laws.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XX  YOUTH CARE FACILITY (YCF):  EDUCATION  (1)  A YCF shall provide access to an educational program appropriate to the needs of each youth and comply with state school attendance laws.

            (2)  A YCF licensed as a youth shelter care facility shall assure that each youth is offered an appropriate educational program and make a reasonable effort to comply with state school attendance laws.

            (3)  The youth shelter care facility shall provide a day program plan for youth who will not be enrolled in the school system.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXI  YOUTH CARE FACILITY (YCF):  RECREATION  (1)  The YCF may have an on-grounds recreation program that is operated by the YCF's staff.  However, when available, the YCF shall provide the youth access to community recreation and cultural events when appropriate to the youth's needs, interests, and abilities.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXII  YOUTH CARE FACILITIES (YCF):  TIME-OUT  (1)  A YCF must develop a written time-out policy and procedures which clearly provide:

            (a)  length of time the youth may remain in time-out which must be age appropriate;

            (b)  guidelines for staff observation of the youth when in time-out;

            (c)  documentation required for each time-out that is directed by staff;

            (d)  purpose of time-out; and

            (e)  staff training pertaining to the use of time-out.

            (2)  Staff may direct a youth to time-out when a youth's behavior is disruptive to the youth's ability to learn, to participate appropriately, or to function appropriately with other youth or the activity, and when other de-escalation techniques have failed.  Restraint, seclusion, or confinement may not be used as part of time-out procedures.

            (3)  Time-out may not be used as punishment.

            (4)  Youth placed in time-out must be reintroduced to the group in a sensitive and nonpunitive manner as soon as control is regained.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXIII  YOUTH CARE FACILITY (YCF):  BEHAVIOR MANAGEMENT POLICIES  (1)  A YCF shall have and follow written behavior management policies and procedures which include a description of the model, program, or techniques to be used with youth.  The YCF shall have policies addressing discipline, therapeutic de-escalation in crisis situations, nonviolent crisis intervention, and time-out.  Behavior management must be based on an individual assessment of each youth's needs, stage of development, and behavior.  It must be designed with the goal of teaching youth to manage their own behavior, and be based on the concept of providing effective treatment by the least restrictive means.

            (2)  The behavior management policies and procedures must prohibit:

            (a)  the use of physical force, mechanical, chemical, or physical restraint as discipline;

            (b)  pain compliance, aversive conditioning, and use of pressure point techniques;

            (c)  placing of anything in or on a youth's mouth;

            (d)  cruel or excessive physical exercise, prolonged positions, or work assignments that produce unreasonable discomfort;

            (e)  verbal abuse, ridicule, humiliation, profanity, and other forms of degradation directed at a youth or a youth's family;

            (f)  physical discipline of any means including but not limited to hitting, shaking, biting, or pinching;

            (g)  locked confinement or seclusion;

            (h)  withholding of necessary food, water, clothing, shelter, bedding, rest, medications as prescribed, medical care, or toilet use;

            (i)  denial of visits or communication with the youth's family as punishment or discipline.  Denial of visits or communication with the youth's family must be in collaboration with the youth's placing agent or by court order;

            (j)  isolation as punishment; and

            (k)  any other form of punishment or discipline which subjects a youth to pain, humiliation, or unnecessary isolation or restraint.

            (3)  If YCF policies and procedures allow for disciplining a group of youth for actions of one youth, the policies and procedures must clearly prescribe the circumstances and safeguards under which disciplining the group is allowed.

            (4)  Any staff person involved in or witnessing an infraction of this rule shall complete an incident report clearly detailing the events of the infraction.  The report must be completed prior to the end of the involved staff person's shift.

            (5)  A copy of the incident report shall be placed in the youth's file and the incident must be reported to the licensure bureau, placing agent, and parent or guardian within one working day of its occurrence.

            (6)  An authorized staff person must be notified of the incident immediately and:

(a)  begin an investigation within 24 hours of incident; and

(b)  complete a written report within two days upon completion of the investigation.

            (7)  An investigation of the incident may be conducted by the department.

            (8)  A complete report of any investigation conducted by the YCF must be placed in the provider's records and must be available for inspection by the department or the youth's placing agency.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXIV  YOUTH CARE FACILITY (YCF):  USE OF NONVIOLENT CRISIS INTERVENTION STRATEGIES  (1)  The YCF shall have written policies and procedures governing the appropriate use of nonviolent crisis intervention strategies, including but not limited to the use of de-escalation techniques and physical restraint methods if used by provider.

            (2)  The nonviolent crisis intervention strategies policies and procedures must comply with the following:

            (a)  Crisis prevention and verbal and nonverbal de-escalation techniques are the preferred methods and must be used first to manage behavior.  All staff working directly with youth must be trained in de-escalation techniques.  This training must be documented in each staff member's personnel file.

            (b)  Physical restraint may only be used to safely control a youth until the youth can regain control of the youth's own behavior.  Physical restraint must only be used in the following circumstances:

            (i)  when the youth has failed to respond to de-escalation techniques and it is necessary to prevent harm to the youth or others; or

            (ii)  when a youth's behavior puts themselves or others at substantial risk of harm and the youth must be forcibly moved.

            (c)  Physical restraint must be used only until the youth has regained control and must not exceed 15 consecutive minutes.  If the youth remains a danger to self or others after 15 minutes, the youth's record must include written documentation of attempts made to release the youth from the restraint and the reasons that continuation of restraint is necessary.

            (d)  Physical restraint may be used only by employees who are documented to be specifically trained in nonviolent crisis intervention techniques.

            (e)  YCF policies and procedures must prohibit the application of a nonviolent physical restraint if a youth has a documented physical condition that would contradict its use, unless a health care professional has previously and specifically authorized its use in writing.  Documentation must be maintained in the youth's record.

            (f)  YCF policies and procedures must require the documentation of:

            (i)  the behavior which required the physical restraint;

            (ii)  the specific attempts to de-escalate the situation before using physical restraint;

            (iii)  the length of time the physical restraint was applied including documentation of the time started and completed;

            (iv)  the identity of the specific staff member(s) involved in administering the physical restraint;

            (v)  the type of physical restraint used;

            (vi)  any injuries to the youth resulting from the physical restraint; and

            (vii)  debriefing completed with the staff and youth involved in the physical restraint.

            (g)  YCF policies and procedures must require that whenever a physical restraint has been used on a youth more than four times within a seven-day period, lead clinical staff members or treatment team members will review the youth's situation to determine the suitability of the youth remaining in the YCF, whether modification to the youth's plan is warranted, or whether staff need additional training in alternative therapeutic behavior management techniques.  The YCF shall take appropriate action as a result of the review.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXV YOUTH CARE FACILITY (YCF):  DISCHARGE SUMMARY

            (1)  Within ten business days of the discharge of a youth from the YCF, a discharge report must be completed, and include:

            (a)  the youth's name, date of birth, admission and discharge dates, reason for placement and discharge, the placing agent, and/or parent or guardian;

            (b)  a written summary of services provided, including the youth's participation and progress in the program, contact information of persons who conducted evaluations of the youth, condition of the youth, compliance with YCF policies and procedures, and recommendations regarding the youth;

            (c)  the youth's educational status;

            (d)  medical, dental, and psychiatric care received during placement;

            (e)  follow-up health care required for the youth;

            (f)  current medications, dosage taken, number of times per day, and name of prescribing licensed health care professional;

            (g)  youth's reaction to discharge and whether or not the discharge was planned or unplanned;

            (h)  recommendations for follow-up services for the youth;

            (i)  an up-to-date inventory of the youth's clothing and personal belongings; and

            (j)  the signature of the staff member who prepared the report and the date of preparation.

            (2)  The original discharge report must be maintained by the YCF in the youth's file and a copy must be provided to the placing agency or legal guardian within ten days of completion.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXVI  YOUTH CARE FACILITY (YCF):  CASE RECORDS

            (1)  A YCF shall maintain a written case record for each youth which shall include administrative, treatment, and educational data from the time of admission until the time the youth is discharged from the YCF.  A youth's case record must include but is not limited to the following:

            (a)  the name, sex, and birth date of the youth;

            (b)  the name, address, and telephone number of the parent(s) or guardian of the youth;

            (c)  date of admission and placing agency;

            (d)  if the youth was not living with the youth's parents prior to admission, the name, address, telephone number, and relationship to the youth of the person with whom the youth was living;

            (e)  date of discharge, reason for discharge, and the name, telephone number, and address of the person or agency to which the youth was discharged;

            (f)  all documents related to the referral of the youth to the facility as provided by the placing agency;

            (g)  current custody and legal guardianship documents as provided by the placing agency;

            (h)  the youth's court status, if applicable;

            (i)  a copy of the youth's birth certificate or a written statement of the youth's birth date, including the source of this information;

            (j)  consent forms signed by the parents or guardian prior to placement allowing the YCF to authorize all necessary medical care, routine tests, immunization, and emergency medical or surgical treatment;

            (k)  cumulative health records including medical history and immunization records as provided by the placing agency;

            (l)  education records and reports, including but not limited to, reports cards and individual education plan (IEP) reports;

            (m)  treatment or clinical records and reports;

            (n)  records of special or critical incidents;

            (o)  case plans, treatment plans, and related material;

            (p)  social assessment that is current to date of placement; and

            (q)  an immediate needs assessment and assigned responsibilities.

            (2)  In addition to the requirements in (1), therapeutic group homes must maintain an updated copy of the youth's clinical assessment.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXVII YOUTH CARE FACILITY (YCF):  SEARCHES  (1)  The provisions of this rule apply to all searches by YCF staff of the youth's person and the youth's personal property, including searches of personal correspondence.  The facts and circumstances supporting a determination of reasonable cause for the search must be documented in the youth's file.

            (2)  Youth may not be subjected to any search except as follows:

            (a)  there is reasonable cause to believe that the search will result in discovery of contraband;

            (b)  there is reasonable cause to believe that the search is necessary to alleviate a threat of harm to the youth, other youths, or staff; or

            (c)  there is a court order/parole order in the youth's case record allowing for searches.

            (3)  The YCF shall adopt policies and procedures relating to searches, including pat-down searches, personal property searches, correspondence searches, urinalysis testing, and breathalyzer testing.  The policies must include but are not limited to the following:

            (a)  a procedure for documenting all searches, reasons for the search, who conducted the search, and the results of the search;

            (b)  notification of the search policy to placing worker or parent/guardian and youth at time of admission;

            (c)  a protocol for conducting personal property searches when the youth is not available to be present for the search;

            (d)  the consequences to a youth when contraband is located;

            (e)  description of what happens to contraband which has been located; and

            (f)  pat-down searches on youth, which must be conducted by staff persons of the same sex.

            (4)  Staff must be trained in the proper protocol for all searches.

            (5)  Youth may not be subjected to any of the following intrusive acts:

            (a)  strip searches;

            (b)  body cavity searches; or

            (c)  video surveillance except in common areas such as the living room, kitchen, and hallways.

            (6)  The YCF shall have adopted policies and procedures prior to use of urinalysis testing which address, at minimum, procedures for obtaining samples for urinalysis testing, procedures for processing urinalysis testing, and consequence to the youth when a urinalysis is positive.

            (a)  Youth may not be subjected to testing unless the testing:

            (i)  has been ordered by a court;

            (ii)  is required pursuant to a case plan for monitoring drug or alcohol use, as approved by the parent, legal guardian, parole officer, or committing agency; or

            (iii)  is requested by the youth's parent or legal guardian.

            (b)  The YCF shall notify the youth's placing worker and custodial parent or guardian of every urinalysis testing performed on the youth and the results.

            (c)  Staff shall document compliance with YCF policies and procedures in connection with each urinalysis testing.

            (7)  The YCF shall have adopted policies and procedures prior to use of breathalyzer testing which address, at minimum, procedures to be used to obtain a breathalyzer test and consequences to the youth when a breathalyzer is positive:

            (a)  Breath testing may only be conducted by appropriate law enforcement personnel and probation, parole, or correctional officer.

            (b)  Youth may be not subjected to breathalyzer testing unless the testimony:

            (i)  has been ordered by a court;

            (ii)  is required pursuant to a case plan for monitoring alcohol use, as approved by the parent or legal guardian; or

            (iii)  is requested by the youth's parent or legal guardian, probation, parole, or correctional officer.

            (c)  The YCF must notify the youth's placing worker and parent or guardian of every breathalyzer test performed on the youth and the results.

            (d)  Staff shall document compliance with YCF policies and procedures in connection with each breathalyzer testing.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXVIII YOUTH CARE FACILITY (YCF): CONTRABAND  (1)  A YCF shall define prohibited contraband in a written policy.

            (2)  Law enforcement must be notified as appropriate when illegal contraband is discovered.

            (3)  All contraband that is not illegal must be returned to the youth's parent or guardian, or destroyed in accordance with the YCF's contraband policy.  When contraband is disposed of, the disposal must be witnessed by at least two staff members and be documented in the youth's case record.

            (4)  If contraband that is not illegal is stored by the YCF, the YCF shall have written policies clearly outlining the storing procedure.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXIX YOUTH CARE FACILITY (YCF):  SAFETY  (1)  A YCF shall have and follow appropriate written policies and procedures on safety and equipment.

            (2)  There must be a first aid kit with sufficient supplies available at all times.  A first aid kit must:

            (a)  be readily available on site as well as in all vehicles used by the YCF;

            (b)  meet the standards of an appropriate national organization for the activity being conducted and the location and environment being used;

            (c)  be reviewed with new staff for contents and use; and

            (d)  be inventoried on a quarterly basis.

            (3)  Policies and procedures must be in place for the safe use and storage of fuels and all heat sources, including inaccessibility to youth when not being used under the direct supervision of staff.

            (4)  Policies and procedures must be in place for the safe use and storage of poisons and toxins as follows:

            (a)  All detergents, chemical sanitizers, and related cleaning compounds and other chemicals must be stored in a safe location that is inaccessible to youth when not being used.

            (b)  Combustible and flammable materials and liquids must be properly stored so as not to create a fire hazard.

            (c)  Poisonous compounds such as insecticide, rodenticide, and other chemicals bearing the EPA toxicity labels "warning" or "danger" must be kept under lock and key.

            (d)  Poisonous or toxic chemicals may not be stored above or adjacent to food, dishes or utensils, or food contact surfaces.  The chemicals may not be used in such a manner that they could contaminate these articles.

            (5)  Emergency information for youth must be easily accessible at the facility.  Emergency information for each youth must include but is not limited to:

            (a)  the name, address, telephone number, and relationship of a designated person to be contacted in case of an emergency;

            (b)  the name, address, and telephone number of the youth's licensed health care professional or source of health care;

            (c)  the name, address, telephone number, and relationship of the person able to give consent for emergency medical treatment;

            (d)  documentation of any medical conditions that may affect care including but not limited to known allergies;

            (e)  a signed release for emergency medical treatment from the parent or legal guardian; and

            (f)  a copy of the youth's current medical insurance card or insurance information when a card is not available to providers.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXX  YOUTH CARE FACILITY (YCF):  POTENTIAL WEAPONS 

            (1)  A YCF shall have and follow written policy and procedures on management of weapons and potential weapons.

            (2)  Firearms must not be allowed on the YCF's property.

            (3)  Firearms must not be in the presence of youth with the exception of law enforcement at any time on or off the YCF's property.

            (4)  Staff shall supervise youth possession and use of knives, hatchets, other edged tools, or any item which may pose a danger to self or others.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXI  YOUTH CARE FACILITY (YCF):  INFECTION CONTROL

            (1)  A YCF shall develop and implement an infection prevention and control program.  At a minimum the facility shall develop, implement, and review, at least annually, written policy and procedures regarding infection prevention and control which must include procedures to identify high risk individuals and what methods are used to protect, contain, or minimize the risk to youth and staff.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXII  YOUTH CARE FACILITY (YCF):  ANIMALS AND PETS

            (1)  The YCF may keep household pets and a youth or staff may have a service animal as defined in ARM 37.40.1487, and permitted by local ordinance, subject to the following provisions:

            (a)  pets must be clean and disease-free;

            (b)  the immediate environment of pets must be kept clean;

            (c)  birds must be kept in appropriate enclosures, unless the bird is a companion breed maintained and supervised by the owner; and

            (d)  pets that are kept at the facility shall have documentation of current vaccinations, including rabies, as appropriate.

            (2)  The administrator or designee shall determine which pets may be brought into the facility.  Upon approval, family members may bring pets to visit, if the pets are clean, disease-free, and vaccinated as appropriate.

            (3)  Facilities that allow birds shall have procedures that protect residents, staff, and visitors from psittacosis, ensure minimum handling of droppings, and require droppings to be placed in a plastic bag for disposal.

            (4)  Prior to admission of companion birds, documentation of the import, out-of-state veterinarian health certificate, and import permit number provided by the pet store or breeder must be provided and maintained in the owner's records.  If the health certificate and import permit number are not available, or if the bird was bred in-state, a certificate from a veterinarian stating that the bird is disease-free is required prior to residency.  If the veterinarian certificate cannot be obtained by the move-in date, the resident may keep the bird enclosed in a private single occupancy room, using good hand washing after handling the bird and bird droppings until the veterinarian examination is obtained.

            (5)  Pets may not be permitted in food preparation, storage, or dining areas during meal preparation time or during meal service or in any area where their presence would create a significant health or safety risk to others.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXIII  YOUTH CARE FACILITY (YCF):  PHYSICAL ENVIRONMENT  (1)  A YCF shall provide a minimum of ten foot-candles of light in all rooms and hallways, with the following exceptions: 

            (a)  All reading lamps must have a capacity to provide a minimum of 30 foot-candles of light.

            (b)  All toilet and bathing areas must be provided with a minimum of 30 foot-candles of light.

            (c)  General lighting in food preparation areas must be a minimum of 30 foot-candles of light.

            (d)  Hallways must be illuminated at all times by at least a minimum of five foot-candles of light at the floor.

            (2)  Adequate space must be provided for all phases of daily living, including recreation, privacy, group activities, and visits from family, friends, and community acquaintances.

            (3)  Youth must have indoor areas of at least 40 square feet of floor space per youth for quiet, reading, study, relaxing, and recreation.  The minimum space requirement may not include halls, kitchens, and any rooms not used by youth may not be included in the minimum space requirement.

            (4)  A bedroom must contain at least 50 square feet of floor space per person.  Bedrooms for single occupancy must have at least 80 square feet.

            (5)  The maximum number of youth per bedroom must not exceed four.  The bedrooms must have floor to ceiling walls.

            (6)  The YCF shall provide:

            (a)  at least one toilet for every four residents; and

            (b)  one bathing facility for every six residents.

            (7)  All resident rooms with toilets or shower/bathing facilities must have an operable window to the outside or must be exhausted to the outside by a mechanical ventilation system.

(8)  Each resident must have access to a bathroom without entering another resident's room, the kitchen, or dining areas.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXIV  YOUTH CARE FACILITY (YCF): WATER SUPPLY

            (1)  An adequate and potable supply of water must be provided.

            (2)  Before a license may be issued, a YCF using an individual, shared, or multiple user water supply must submit the following to the department or its designee:

            (a)  satisfactory coliform bacteria and nitrate test results as specified in ARM Title 17, chapter 38, subchapter 2; and

            (b)  the results of an onsite sanitary survey of the water supply system to detect sanitary deficiencies.

            (3)  A supplier of an individual, shared, or multiple user water supply shall conduct a coliform bacteria test of the system at least twice a year with one sample collected between April 1 through June 30 and the second sample collected between August 1 through October 31, and conduct a nitrate test of the system at least once every three years.  Water tests must be analyzed at a certified laboratory.  A supplier shall keep sampling result records for at least three years.

            (4)  A public water supply system must be constructed and operated in accordance to current applicable laws as regulated by the Montana Department of Environmental Quality.

            (5)  Nonpotable water sources must be marked "not for human consumption".

            (6)  Plumbing must be installed and maintained in a manner to prevent cross connections between the potable water supply and any nonpotable or questionable water supply or any source of pollution through which the potable water supply might become contaminated.  The potable water system must be installed to preclude the possibility of backflow.  A hose may not be attached to a faucet unless a backflow prevention device is installed.

            (7)  A water supply system is determined to have failed and requires treatment, replacement, repair, or disinfection, when the water supply becomes unsafe, or when it exceeds the maximum contaminant levels specified in ARM Title 17, chapter 38, subchapter 2.  A water supply system is inadequate when it is found to be less than 20 psi measured at the extremity of the distribution line during the instantaneous peak usage.

            (8)  Extension, alteration, repair, or replacement of a water supply system or development of a new water supply system must be in accordance with all applicable state and local laws.

            (9)  Bottled and packaged potable water must be obtained from a licensed and approved source and be handled and stored in a way that protects it from contamination.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXV  YOUTH CARE FACILITY (YCF):  SEWAGE SYSTEM AND SOLID WASTE  (1)  An adequate and safe wastewater system must be provided for conveying, treating, and disposing of all sewage.  Immediate measures must be taken to alleviate health and sanitation hazards caused by wastewater at the YCF when they occur.

            (2)  All sewage, including liquid waste, must be disposed of by a public sewage system approved by the Montana Department of Environmental Quality or by a sewage treatment and disposal system constructed and operated in accordance to applicable state and local laws.

            (3)  A wastewater system has failed and requires replacement or repair if any of the following conditions occur:

            (a)  the system fails to accept, treat, or dispose of wastewater as designed;

            (b)  effluent from the wastewater system contaminates a potable water supply or state waters; or

            (c)  the wastewater system is subjected to mechanical failure, including electrical outage, or collapse or breakage of a septic tank, lead line, or drainfield line.

            (4)  Extension, alteration, replacement, or repair of any wastewater system must be done in accordance with all applicable state and local laws.

            (5)  Mop water or soiled cleaning water may not be disposed of in any sink other than a mop or utility sink or a toilet.

            (6)  Solid waste must be collected, stored, and disposed of in a manner that does not create a sanitary nuisance.  Solid waste must be removed from the premises at least weekly to a licensed solid waste disposal facility.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXVI  YOUTH CARE FACILITY (YCF):  FOOD PREPARATION AND HANDLING  (1)  Safe food handling and preparation practices must be followed in all YCFs.

            (2)  The minimum hand washing requirements include the following:

            (a)  The facility must have conveniently located hand washing facilities, supplied with hand soap, disposable towels kept clean in a dispenser, and cleanable trash can.

            (b)  An individual in a YCF handling or preparing food shall thoroughly wash hands, wrists, and exposed arms with soap and warm running water for at least 20 seconds:

            (i)  before touching anything used to prepare food;

            (ii)  before touching food that will not be cooked;

            (iii)  after touching raw meat, fish, or poultry;

            (iv)  after cleaning, handling dirty dishes, removing garbage, or storing supplies;

            (v)  after using the toilet facilities;

            (vi)  after eating or drinking;

            (vii)  after touching the face, hair, or skin;

            (viii)  after blowing the nose, coughing, or sneezing; and

            (ix)  after touching any soiled object.

            (c)  After handwashing, hands must be dried and faucets turned off with a clean paper towel.

            (d)  If used, chemical hand sanitizers must be followed by thorough hand rinsing before contact with food.

            (3)  General food safety requirements include the following:

            (a)  All food must be from an approved source and shall be transported, stored covered, prepared, and served in a sanitary manner to prevent contamination.

            (b)  Food must be free from adulteration or other contamination and must be safe for human consumption.

            (c)  Milk and other dairy products must be pasteurized.

            (d)  Use of home canned foods other than jams, jellies, and fruits is prohibited.

            (e)  Use of thermometers is required to check food temperatures.

            (f)  Cold storage of potentially hazardous food must be at 41°F or below.

            (g)  Frozen food must be kept frozen.

            (h)  Hot storage of potentially hazardous food must be 135°F or above.

            (i)  Each type of food must be stored and arranged so that cross-contamination of one type with another is prevented.

            (j)  Raw fruits and vegetable must be thoroughly washed in potable water to remove soil and other contaminants before being cut, combined with other ingredients, cooked, served, or offered for human consumption in ready-to-eat form.  Fruits and vegetables may be washed by using chemicals approved by the EPA.

            (4)  General health and safety requirements include the following:

            (a)  Use clean cutting boards, knives, can openers, and other equipment and utensils for each type of food preparation to prevent cross-contamination.

            (b)  A person with symptoms of a communicable disease that can be transmitted to foods or who is a carrier of such a disease may not work with food, clean equipment, or clean utensils.

            (c)  When the regulatory authority has reasonable cause to suspect possible disease transmission within a YCF, the YCF shall take appropriate action in accordance with ARM Title 37, chapter 114 regarding communicable disease control.

            (d)  The person in charge at the YCF shall contact the regulatory authority immediately in the event of a fire, flood, power outage, or similar event that might result in the contamination of food, or that might prevent potentially hazardous food from being held at required temperatures.

            (5)  Minimum food storage requirements include the following:

            (a)  Food must be stored to prevent potential contamination.

            (b)  Food packages must be in good condition and protected of their contents so that the food is not exposed to adulteration or potential contaminants.

            (c)  Working containers holding food or food ingredients that are removed from their original packages must be identified with the common name of the food.

            (d)  Packaged food may not be stored in direct contact with water or undrained ice if the food package could allow water entry.

            (6)  Equipment and utensil sanitation requirements include the following:

            (a)  Kitchenware, tableware, and food contact surfaces must be washed, rinsed, and completely dried after each use.

            (b)  Moist cloths used for wiping kitchen and dining area surfaces, equipment, and utensils must be placed in chemical sanitizer solution frequently enough and be of sufficient strength to maintain 200 to 400 parts per million (ppm) available chlorine or equivalent.

            (c)  Sinks used for food preparation must be cleaned before beginning the preparation of the food.

            (7)  A domestic style dishwasher may be used only if it is equipped with a heating element and the following conditions are met:

            (a)  The dishwasher must be capable of washing and sanitizing all dishware, utensils, and food service equipment normally used for the preparation and service of a meal in one cycle.

            (b)  The dishwasher must have water at a temperature of at least 165°F when it enters the machine, if it uses hot water for sanitization.

            (c)  If it uses a heat cycle with a heating element for sanitization, the dishwasher must be allowed to run through the entire cycle before it is opened.

            (d)  At least a two-compartment sink must be available as a backup in the event the dishwasher becomes inoperable.

            (8)  If a two-compartment sink is used, all dishware, utensils, and food service equipment must be thoroughly cleaned in the first sink compartment with a hot detergent solution that is kept clean and at a concentration indicated on the manufacturer's label, sanitized in the second compartment by immersion in any chemical sanitizing agent that will provide the equivalent bactericidal effect of a solution containing at least 100 ppm but not more than 200 ppm of available chlorine at a temperature of at least 75°F for one minute, and air-dried before being stored.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXVII  YOUTH CARE FACILITY (YCF):  EMERGENCY AND EVACUATION PLANS  (1)  A YCF shall have and follow a written emergency plan developed in conjunction with emergency services in the community, and it must include specific procedures for evacuations, disasters, medical emergencies, hostage situations, casualties, missing youth, and other serious incidents identified by the YCF.

            (2)  The emergency plan must, at a minimum, include:

            (a)  designation of authority and staff assignment;

            (b)  a specific evacuation plan;

            (c)  provisions for transportation and relocation of YCF participants when necessary;

            (d)  provisions for supervision of youth after an evacuation or relocation;

            (e)  provisions for the instruction of all participants on how to respond in the case of an emergency; and

            (f)  provisions for arranging medical care and notifying a youth's licensed health care professional, placing agent, and parent or guardian.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXVIII  YOUTH CARE FACILITY (YCF):  FINANCES  (1)  Each YCF shall:

            (a)  provide a sound financial plan to carry out its defined purposes and provide proper care for children;

            (b)  provide documentation of sufficient funds or resources for its first year of operation and be able to furnish evidence to that effect;

            (c)  maintain financial records of all receipts, disbursements, assets, and liabilities; and

            (d)  upon request by the department, have all accounts audited by an independent auditor who is not regularly employed by the YCF or a member of the YCF's board of directors.

            (2)  Financial responsibility for medical and dental treatment must be established prior to placement and must usually lie with the parent, guardian, custodian, and/or referring party of the child.

            (3)  The YCF must show proof that professional or general liability insurance is in effect for the protection of the YCF, staff, and youth.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XXXIX  THERAPEUTIC GROUP HOMES (TGH):  STAFFING

            (1)  In addition to the requirements specified in [NEW RULE XXXIX], TGH providers must meet staffing requirements specified in this rule to provide a therapeutic environment and treatment interventions identified in the youth's individual treatment plan.

            (2)  A TGH with four or fewer youth shall have a ratio of youth to direct care staff of no more than 2:1 each day for a 15-hour period beginning at, or between 7:00 a.m. and 7:30 a.m., or beginning at some other reasonable morning half hour which is approximately 15 hours prior to the bedtime of the youth.

            (3)  A TGH with five or more shall have a minimum of two direct care staff present for 15 hours each day between 7:00 a.m. and 7:30 a.m., or beginning at some other reasonable half hour which is approximately 15 hours prior to the bedtime of the youth.

            (4)  Exceptions to youth to direct care staff ratio:

            (a)  During regular school hours when youth are not normally present, at least one on-call staff must be available.  Staff must report to work at the TGH within 30 minutes of notification that they are needed.

            (b)  If no more than two youths do not attend school and remain in the TGH, the program manager may be counted in the direct care staff ratio.

            (5)  A minimum of one direct care staff must be present and awake nine hours each night at or between 10:00 p.m. and 7:00 a.m., or no earlier than 15 hours from the time daytime staffing start working.  In addition, one on-call staff must be available each night and report to work within 30 minutes of notification that they are needed.

            (6)  Each program manager shall be responsible for no more than two TGH.  The program manager may not be counted in the direct care staffing to youth ratio except as provided in (4)(b).

            (7)  An individual providing mental health professional services shall meet the requirements of ARM 37.87.702.

            (8)  Program managers and lead clinical staff may be the same employee as long as they meet the minimum qualifications of both positions and have sufficient time to carry out the functions of both positions.

            (9)  Lead clinical staff shall be responsible for the supervision and overall provision of treatment services to youth in the TGH.  The lead clinical staff must not be counted in the direct care staff to youth ratio.

            (10)  Adequate staff must be employed to implement each youth's individualized treatment plan.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XL  THERAPEUTIC GROUP HOMES (TGH):  CLINICAL ASSESSMENT  (1)  A clinical assessment must be completed on a youth admitted to a TGH within ten business days (Monday through Friday), of admission unless a current clinical assessment that has been completed within the last 72 months is submitted with the youth's referral packet.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XLI  THERAPEUTIC GROUP HOMES (TGH):  THERAPY REQUIREMENTS  (1)  Each youth must receive from the lead clinical staff 150 minutes per week (Sunday through Saturday) of individual, group, and family therapy as clinically indicated based on the specific treatment needs of the youth.  Therapy requirements include the following:

            (a)  Individual therapy must be provided at least 50 minutes out of the required 150 minutes per week.  Individual therapy may be provided in two 25- minute sessions per week as clinically appropriate.  The lead clinical staff shall document specific reasons why a 50-minute therapy session cannot be provided.

            (b)  Family therapy must be provided to the youth and biological, adoptive, or foster family members with whom the youth previously resided or plans to reside with upon discharge.  If family therapy is not appropriate based on the particular situation of the youth, the lead clinical staff shall document specific reasons why family therapy cannot be provided.

            (2)  Therapy sessions must address the youth's treatment goals and objectives in the treatment plan, and each session must be documented in the case record by the lead clinical staff.  Documentation must include the signature of the person who provided the therapy and the date, start and end times of each session.

            (3)  Internal staff meetings to address the needs of each youth must be conducted weekly and must include the program manager, lead clinical staff, and direct care staff.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

            NEW RULE XLII  THERAPEUTIC GROUP HOMES (TGH):  TREATMENT PLAN  (1)  In addition to the requirements specified in [NEW RULE X], the treatment plan must document specific and measurable objectives and interventions based on a clinical assessment related to the youth's mental health needs.

            (2)  Treatment plans must be reviewed and updated at least every 30 days.

            (3)  All direct care staff and treatment team members, including the lead clinical staff involved in the care of the youth, shall read and sign off on the treatment plan within seven days of its development or update.

            (4)  A copy of the treatment plan must be provided to the youth's placing agency and custodial parent or guardian within seven days of the plan's development or update.

 

AUTH:  52-2-111, 52-2-603, 52-2-622, MCA

IMP:  52-2-113, 52-2-603, 52-2-622, MCA

 

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

 

            37.97.101  YOUTH CARE FACILITY (YCF):  PURPOSE  (1)  These rules establish licensing procedures and licensing requirements for youth care facilities.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 52-2-111, 52-2-603, 52-2-622, 53-4-111, MCA

IMP:  41-3-501, 41-3-503, 41-3-1102, 41-3-1142, 52-2-113,  52-2-602, 52-2-622, 53-2-201,  53-4-113, MCA

 

            37.97.102  YOUTH CARE FACILITY (YCF):  DEFINITIONS  (1)  The following definitions apply to all YCF licensing rules:

            (1)  "Chemical restraint" means the use of a drug or medication that is used to control behavior or restrict the youth's freedom of movement, and which is not a standard treatment for the youth's medical or psychiatric condition.  The use of chemical restraint is prohibited in all YCFs.

            (2)  "Child" or "youth" means any person under the age of 18 years, without regard to emancipation, except for youth covered by Montana Medicaid programs which allow for participation of youth up to the age of 21 years as defined in ARM 37.87.102.

            (3)  "Child care agency" means any YCF in which substitute care is provided to 13 or more youth.

            (4)  "Clinical assessment" means a psychological assessment with DSM - IV diagnosis and a social history completed by the lead clinical staff or an in-training mental health professional supervised by the lead clinical staff.  Clinical assessments include the following information:

            (a)  diagnosis supported by a rationale and specific behaviors;

            (b)  trauma history;

            (c)  chemical dependence issues;

            (d)  presenting problem;

            (e)  history of problem;

            (f)  psychiatric history (interventions, responses to treatment, medications);

            (g)  social and educational history; and

            (h)  risk factors.

            (5)  "Correspondence search" means opening, inspecting, and/or reading a youth's mail or inspecting the contents of a package.

            (6)  "Department" means Department of Public Health and Human Services.

            (7)  "Direct care staff" means YCF personnel who directly participate in the care, supervision, and guidance of youth in a YCF.

            (8)  "Discharge plan" means a realistic plan developed to transition the youth to a less restrictive and appropriate placement with specific services identified and available.

            (9)  "In-training mental health professional" is defined in ARM 37.87.702.

            (10)  "Lead clinical staff (LCS)" means an employee of the therapeutic group home (TGH) provider.  The LCS is responsible for the supervision and overall provision of treatment services to youth in the TGH .  The LCS must be a licensed clinical psychologist, licensed master level social worker (MSW), or licensed clinical professional counselor (LCPC).  The LCS can be an in-training mental health professional.

            (11)  "Licensure bureau" means the area of the department responsible for licensing a YCF.

            (12)  "Maternity home" means a YCF which provides for the care and maintenance of youth during pregnancy, childbirth, and postnatal periods.  A maternity home must meet the licensing requirements of a child care agency regardless of the number of residents served.

            (13)  "Mechanical restraint" means the use of devices as a means of restricting a youth's freedom of movement.  The use of mechanical restraint is prohibited in any YCF.

            (14)  "Pat-down search" means a body search done outside of a youth's clothing with the intention of locating suspected contraband.

            (15)  "Personal property search" means a search which includes but is not limited to going through a youth's personal property and/or room including closet, bed, desk, dresser drawers, etc., with the intention of looking for contraband.

            (16)  "Physical escort" means the temporary touching or holding of the hand, wrist, arm, shoulder, or back for the purpose of inducing a youth who is acting out to walk to a safe location.

            (17)  "Physical restraint" means a personal restriction that immobilizes or reduces the ability of the free movement of an individual's arms, legs, or head.  Such term does not include physical escort.  Physical restraint may be imposed only in emergency circumstances and only to ensure the immediate physical safety of the resident, a staff member, or others, when less restrictive interventions have been determined to be ineffective.

            (18)  "Program manager" means an employee of a therapeutic group home provider who trains and supervises direct care staff.  A program manager shall have a bachelor's degree in human services, or the experience and education, equivalent to a bachelor's degree.  Human services experience equivalent to a bachelor's degree for a nondegree program manager is six years.  Each year of post-secondary education in human services for a nondegree program manager equals one year of experience.

            (19)  "Seclusion" means a behavior control technique involving locked isolation in which the resident is physically prevented from leaving.  Such term does not include time-out.  Seclusion is prohibited in licensed YCFs.

            (20)  "Serious incident" means suicide attempt, use of excessive physical force by staff, physical or sexual assault of a youth by resident or staff, injury to a youth which requires emergency medical care, known or suspected abuse or neglect of a youth by staff or resident, or the death of a youth.

            (21)  "Substitute care" means the full-time care of youth in a residential setting for the purpose of providing food, shelter, security and safety, guidance, direction, and, if necessary, treatment to youth who are removed from or who are without the care and supervision of their parents or guardian.

            (22)  "Therapeutic milieu" means the entire treatment environment in which comprehensive treatment is delivered.

            (23)  "Therapeutic services" means the provision of psychotherapy and related services as defined in [New Rule I published at MAR Notice No. 37-518] by the lead clinical staff acting within the scope of the professional's license or provided by an in-training practitioner in a therapeutic group home.

            (24)  "Therapeutic group home (TGH)" means a treatment facility providing therapeutic services licensed and under contract with the department as a YCF with the supervision and intensity of treatment required to manage and treat up to eight youth who present severe emotional disturbance (SED) and/or behavioral disorders as determined by the department.

            (25)  "Time-out" means the restriction of a youth for a period of time to a designated area from which the resident is not physically prevented from leaving for the purpose of providing the youth the opportunity to regain self control.

            (26)  "Youth care facility (YCF)" means a licensed facility in which substitute care is provided to youth and includes youth foster homes, youth group homes, youth shelter care facilities, therapeutic group homes, and child care agencies.

            (27)  "Youth group home" means a YCF in which substitute care is provided to seven to 12 youth.

            (28)  "Youth group home manager" means an employee of a regular youth group home.  The group home manager trains and supervises direct care staff and provides supervision to youth in care no more than 50 percent of the time.  A group home manager must have a bachelor's degree in human services, or the experience alone or experience with and education equivalent to a bachelor's degree.  Human services experience equivalent to a bachelor's degree for a nondegree manager is six years.  Each year of post-secondary education in human services for a nondegree manager equals one year of experience.

            (29)  "Youth shelter care facility" means a YCF that regularly serves youth under temporary conditions until the court, probation office, the department, or other appropriate social agency has made other provisions for their care.

            (30)  "Youth shelter care manager" means an employee of a youth shelter care home.  The shelter care manager trains and supervises direct care staff and provides supervision to youth in care no more than 50 percent of the time.  A shelter care manager must have a bachelor's degree in human services, or the experience and education equivalent to a bachelor's degree.  Human services experience equivalent to a bachelor's degree for a nondegree manager is six years.  Each year of post-secondary education in human services for a nondegree manager equals one year of experience.

            (31)  "Youth/staff ratio" means number of youth in care per each on-duty direct care staff member.

            (a)  Except in regard to age requirements under Montana medicaid programs which allow for participation of youth up to the age of 21 years, "child" or "youth" means any person under the age of 18 years, without regard to sex or emancipation.

            (b)  "Substitute care" means full-time care of youth in a residential setting for the purpose of providing food, shelter, security and safety, guidance, direction, and, if necessary, treatment to youth who are removed from or who are without the care and supervision of their parents or guardian.

            (c)  "Youth care facility" (YCF) means a licensed facility in which substitute care is provided to youth and includes youth foster homes, youth group homes, youth shelter care facilities, therapeutic youth group homes, and child care agencies.

            (d)  "Youth foster home" or "foster care home" or "boarding home" means a YCF in which substitute care is provided to one to six children or youth to whom the foster parents are not related by blood, marriage, adoption or wardship.

            (e)  "Youth group home" means a YCF in which substitute care is provided to seven to 12 children or youth.

            (f)  "Child care agency" means any YCF in which substitute care is provided to 13 or more children.

            (g)  "Youth shelter care facility" means a YCF which regularly receives children under temporary conditions until the court, probation office, the department, or other appropriate social agency has made other provisions for their care.

            (h)  "Maternity home" means a YCF which provides for the care and maintenance of minor girls and adult women during pregnancy, childbirth, and postnatal periods.  A maternity home must meet the licensing requirements of a child care agency regardless of the number of residents served.

            (i)  "Child care staff" means YCF personnel who directly participate in the care, supervision and guidance of children in a YCF.

            (j)  "Houseparent" means a staff member whose primary responsibility is the day-to-day care of children in a youth group home.

            (k)  "Foster parent" means a person responsible for the day-to-day care, supervision and guidance of children in a youth foster home.

            (l)  "Department" means department of public health and human services.

            (m)  "Time-out" means the placement of a child for a period of less than 30 minutes in an unlocked room.

            (n)  "Restraint" means the extraordinary restriction of a child's freedom or freedom of movement.

            (o)  "Passive physical restraint" means the least amount of direct physical contact required by a staff member using approved methods of making such physical contact to restrain a child from harming self or others.

            (p)  "Child/staff ratio" means number of children in care per each on-duty child care staff member.

            (2)  The following definitions apply only to child care agencies which operate an approved residential treatment center:

            (a)  "Residential treatment center" means a unit or facility of a child care agency that treats children who are seriously disturbed either mentally, emotionally or behaviorally.  In addition to the child care agency rules, such unit or facility must meet the licensing requirements contained in ARM 37.97.250, 37.97.253, 37.97.254, 37.97.257, 37.97.258 and 37.97.259.

            (b)  "Seclusion" means isolation of a child in a locked room.  Seclusion may be used to protect the child, other children, and staff and to give the child the opportunity to regain control of his or her behavior and emotions by providing definite external boundaries and decreased stimulation.

            (c)  "Chemical restraint" means the use of psychotropic medication to subdue, inhibit, confine or control a child's behavior.

            (d)  "Mechanical restraint" means the restriction by mechanical means of a child's mobility and/or ability to use his/her hands, arms or legs.

            (3)  Additional definitions for youth care facilities licensed as therapeutic youth group homes are found in ARM 11.13.101.

            (4)  The following definitions apply only to youth shelter care facilities:

            (a)  "Pat down search" means a body search done outside of a youth's clothing with the intention of locating suspected contraband.

            (b)  "Personal property search" means a search which involves going through a youth's personal property and/or room including closet, bed, desk, dresser drawers, etc., with the intention of looking for contraband.

            (c)  "Correspondence search" means opening, inspecting and/or reading a youth's mail or inspecting the contents of a package. 

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, 52-2-603, 52-2-622, 53-4-111, MCA

IMP:  41-3-1102, 41-3-1142, 52-2-113, 52-2-602, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.105  YOUTH CARE FACILITY (YCF):  LICENSE REQUIRED

            (1)  Every youth care facility YCF shall be licensed by the department, or responsible tribal authority.

            (2)  Failure of a provider to obtain or renew a license while continuing to operate a youth care facility YCF is a misdemeanor and shall be subject to the penalties provided in 41-3-504, MCA.

 

AUTH:  41-3-503, 53-4-111 52-2-111, 52-2-622, MCA

IMP:  41-3-502, 41-3-504, 41-3-1103, 41-3-1141, 41-3-1143, 52-2-113, 52-2-603, 52-2-621, 52-2-623, 53-2-201, 53-4-113, MCA

 

            37.97.106  YOUTH CARE FACILITY (YCF):  LICENSES  (1)  One-year licenses.  The department shall issue a one year youth care facility YCF license to any license applicant that meets all licensing requirements established by these rules, as determined by the department after a licensing study survey, or, that is licensed or otherwise approved by another state agency.

            (a) and (a)(i) remain the same.

            (ii)  the YCF continues to meet all licensing requirements established by these rules, as determined by the department after a relicensing study survey.

            (b)  If a YCF makes timely application for renewal of a license, but the department fails to complete the relicensing study survey before the expiration date of the previous year's license, the previous year's license will continue in effect for the time necessary for the department to complete the relicensing study survey and to make a determination of compliance with licensing requirements.

            (2)  Provisional license.  The department may in its discretion issue a provisional license for any period up to 6 six months to any license applicant which:

            (a) and (b) remain the same.

            (i)  The department may in its discretion renew a provisional license if the license applicant shows good cause for failure to comply fully with all licensing requirements within the time period covered by the prior provisional license, but the total time period covered by the initial provisional license and renewals may not exceed 1 one year.

            (3)  Restricted license.  A restricted license may be issued for the care of a specific child with the approval of the department.

            (4) remains the same.

            (5)  The current YCF license shall be publicly displayed at the YCF.  No applicant(s) shall be newly licensed for a youth foster home if any one of the following has occurred within 12 months of the application, unless an exception is granted by the department:

            (a)  a death of a spouse or child in the applicant's family;

            (b)  a marital separation or divorce of the applicant(s);

            (c)  an adoption of a child who has not been living with the adoptive parent(s);

            (d)  the birth of a child to the applicant(s); or

            (e)  loss of employment by the applicant;

            (f)  If (5)(a), (b), (c), (d) or (e) occur in a licensed foster home, the foster parent(s) shall notify the licensing social worker within 48 hours.  The licensing social worker will reevaluate the home within 30 days to determine whether there should be any change in the licensing status.

            (6)  If a couple, the applicant(s) shall have been together for at least 24 months.

            (7)  Any applicant who has received services for substantiated abuse or neglect of a child as defined in ARM 37.47.602(1)(m) shall be denied a foster care license unless special approval is given by the regional administrator after careful review of extenuating circumstances which justify the issuance of a restricted license.

            (8)  Any applicant whose own children have been in foster care should be denied a foster care license, unless an exception is granted by the department because the circumstances leading to the provision of services or the placement no longer exists.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111 52-2-111, 52-2-603, 52-2-622, MCA

IMP:  41-3-1103, 41-3-1142, 52-2-113, 52-2-603, 52-2-622 53-4-113, MCA

 

            37.97.110  YOUTH CARE FACILITY (YCF):  LICENSING PROCEDURES

            (1) remains the same.

            (2)  The YCF shall submit all written program management policies and procedures to the department for approval with the initial application.  Policies and procedures must comply with requirements outlined in this chapter.  The YCF shall submit to the department any significant changes to policies and procedures for approval.

            (2) (3)  Upon receipt of an a complete application for license or renewal of license, the department shall conduct a licensing study survey to determine if the applicant meets all applicable licensing requirements for licensure as established in these rules.

            (3) (4)  If the department determines during the survey that an application or accompanying information is incomplete or erroneous, it the applicant is out of compliance with the applicable licensing requirements, the department will notify the applicant of the specific deficiencies or errors, and the applicant shall submit the required or corrected information a written plan of correction within 60 ten working days of the department's notification of noncompliance specifying how compliance will be made.  The department shall not issue a license or renew a license until it receives all required or corrected information.

            (5)  The department must approve the plan of correction prior to issuing a license.

            (6)  The department shall not issue a license or renew a license until it receives all required or corrected information.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 53-4-111 52-2-111, 52-2-603, 52-2-622, MCA

IMP:  41-3-503, 41-3-1103, 41-3-1142, 52-2-113, 52-2-603, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.115  YOUTH CARE FACILITY (YCF):  LICENSE REVOCATION AND

DENIAL, SUSPENSION, RESTRICTION, AND REVOCATION  (1)  The department, after written notice to the applicant or licensee, may deny, suspend, restrict, revoke, or reduce to a provisional status a license upon a finding of any of the following that:

            (a)  the YCF is not in compliance with fire safety standards; or

            (b)  the YCF is not in substantial compliance with any other licensing requirements established by this rule; or chapter;

            (c)  the YCF has made any misrepresentations to the department, either negligent or intentional, regarding any aspect of its operations or facility; or

            (d)  the YCF has failed to use the foster care payments for the support of the foster child; or

            (e)  the YCF or its staff have been named as the perpetrator in a substantiated report of abuse or neglect; or

            (f)  the YCF or any member of its staff has violated provisions of this subchapter that resulted in child abuse or neglect;

            (g)  the YCF or any member of its staff do not meet the requirements in [New Rule III];

            (f) (h)  the YCF failed to report an incident of abuse or neglect to the department or its local affiliate as required by 41-3-201, MCA.;

            (g) (i)  it is determined on the basis of a department or law enforcement investigation that the YCF, its staff, or anyone living in a YCF household may pose any risk or threat to the safety or welfare of any youth placed in the YCF.; or

            (j)  the YCF has failed to provide an acceptable written plan of correction as specified in ARM 37.97.110.

            (2)  At the discretion of the department and for protection of the child(ren) in placement the child(ren) youth, youth may be moved immediately upon receipt of a report of sexual or physical abuse or neglect by the YCF.

            (3)  Any person denied a license under the provisions of this subchapter, or whose license has been suspended, restricted, revoked, or reduced to a provisional status, may request a hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 53-4-111, 52-2-111, 52-2-603, 52-2-622, MCA

IMP:  41-3-503, 41-3-1103, 41-3-1142, 52-2-113, 52-2-603, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.128  YOUTH CARE FACILITY (YCF):  CONFIDENTIALITY OF RECORDS AND INFORMATION  (1)  All records maintained by a YCF and all personal information made available to a YCF pertaining to an individual child youth must be kept confidential and are not available to any person, agency, or organization except as specified in (2) through (4) of this rule.

            (2)  All records pertaining to an individual child youth are available upon request to:

            (a)  the child's youth's parent, guardian, legal custodian, or attorney absent specific and compelling reasons for refusing such records;

            (b)  a court with continuing jurisdiction over the placement of the child youth or any court of competent jurisdiction issuing an order for such records;

            (c)  a mature child youth to whom the records pertain, absent specific and compelling reasons for refusing specific records; or

            (d)  an adult who was formerly the child youth in care to whom the records pertain absent specific and compelling reasons for refusing such records.

            (3)  All records pertaining to individual children youth placed by the department are available at any time to the department or its representatives.

            (4)  Records pertaining to individual children youth not placed by or in the custody of the department shall be available to the department for the purposes of licensing or relicensing the YCF.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 53-4-111 52-2-111, 52-2-603, 52-2-622, MCA

IMP:  41-3-503, 41-3-1142, 52-2-113, 52-2-622, 53-2-105, 53-2-106, 53-2-201, 53-4-113, MCA

 

            37.97.130  YOUTH CARE FACILITY (YCF):  REPORTS  (1) remains the same.

            (2)  The YCF (except youth foster homes) shall report any of the following changes in writing to the department's licensure bureau, prior to the effective date of the change:

            (a) remains the same.

            (b)  a change in location of which the department shall approve prior to the move;

            (c)  a change in the name of the agency, program, or facility; or

            (d)  a any significant change in the organization, administration, purposes, programs, or services.

            (3)  Youth foster homes shall report a change of residence to the department prior to moving and the department shall evaluate the new residence within 30 days of receiving the report.

            (4)  As required by 41-3-201, MCA, the provider or staff member shall report within 24 hours any incidents of known or suspected child abuse or neglect to the local county welfare office or the state child abuse hot line 1-800-332-6100. 

            (a)  If no action is taken on the referral, or if the above resources are not available at the time, reports shall be made to the department of public health and human services district or state office.

            (b)  Each child care agency shall require each staff member of the agency to read and sign a statement which clearly defines child abuse and neglect and outlines the staff member's responsibility to report all incidents of child abuse or neglect according to state law to the department or its local affiliate and to the chief administrator of the agency or a person designated by the administrator.

            (c)  Each child care agency shall report any suspected or alleged incident of child abuse or neglect to the department and cooperate fully in the investigation of any incident.

            (d)  Each child care agency shall have written procedures for handling any suspected incident of child abuse including:

            (i)  a procedure for ensuring that the staff member involved does not work directly with the child involved until the investigation is completed;

            (ii)  a procedure for conducting in-house investigation of the incident;

            (iii)  a procedure for disciplining any staff member involved in an incident of child abuse; and

            (iv)  a procedure for notification of the county welfare department.

            (5)  Any serious incident involving a child shall be reported within the next working day to the person or agency which placed the child and to the licensing worker.

            (a)  A "serious incident" means suicide attempts, excessive physical force by staff, sexual assault by residents or staff, injury to a child which requires hospitalization, or the death of a child.

            (b)  The YCF shall complete a written incident report concerning any serious incident involving a child.  The report shall include the date and time of the incident, the child involved, the nature of the incident, description of the incident and the circumstances surrounding it.  A copy of the report shall be filed at the YCF and a copy shall be sent to the licensing worker.

            (6) (3)  Runaways shall be reported immediately to the police and within the next working day to the agency or person who placed the child youth.

            (7) remains the same but is renumbered (4).

            (8)  The current YCF license shall be publicly displayed at the YCF.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 53-4-111 52-2-111, 52-2-603, 52-2-622, MCA

IMP:  41-3-503, 41-3-1142, 52-2-113, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.132  YOUTH CARE FACILITY (YCF):  GENERAL REQUIREMENTS FOR ALL ADMINISTRATORS, STAFF, INTERNS, AND VOLUNTEERS FOSTER PARENTS AND CHILD CARE STAFF WORKING IN YOUTH GROUP HOMES AND CHILD CARE AGENCIES  (1)  A YCF shall have written personnel and program policies and procedures covering but not limited to the following items:

            (a)  screening procedure for all applicants;

            (b)  job qualifications;

            (c)  job descriptions;

            (d)  supervisory structure; and

            (e)  performance evaluations.

            (2)  A YCF shall maintain records for each staff member, volunteer, and intern regarding the following:

            (a)  application for employment;

            (b)  written results of at least two references;

            (c)  record of orientation and ongoing training;

            (d)  periodic performance evaluations;

            (e)  copy of current licenses and certifications;

            (f)  documentation of criminal background check as specified in [NEW RULE III];

            (g)  documentation of child protective services background checks as specified in [NEW RULE III];

            (h)  "personal statement of health for licensure" form as provided by the department; and

            (i)  any other employee records required by this subchapter.

            (1) (3)  In addition to the specific requirements set out in subchapters 1 and 2, 4, and 6, of this chapter, child care all staff working in a YCF group homes and child care agencies, and foster parents, must:

            (a)  be at least 18 21 years of age;

            (b)  be of good moral character have a high school diploma or GED;

            (c)  be physically, mentally, and emotionally competent to care for children youth; and

            (d)  like and understand children; and

            (e) (d)  be in good general health.

            (2) (4)  The department may require an psychological evaluation or medical examination of, and/or a signed authorization for release of medical or psychological records from: any YCF staff, intern, or volunteer if there are grounds to believe these individuals have engaged in behaviors which may place the YCF youth at risk of harm.

            (a)  any person applying for licensure as a foster parent, or any member of the household of a person applying for licensure as a foster parent;

            (b)  any foster parent, or any member of a foster parent household; and

            (c)  any person defined as child care staff.

            (3) (5)  A "personal statement of health for licensure" form provided by the department must be completed for each person subject to the requirements of this rule.  The form must be submitted to the department with the initial application for licensure upon hire and annually thereafter.  The "personal statement of health for licensure" form is available from the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

            (4)  The department may require completion of a criminal background and child and adult protective services check on each person subject to the requirements of this rule.

            (6)  Any YCF staff member, intern, volunteer, or other person whose behavior or health status endangers the residents may not be allowed at the YCF.

            (7)  YCF volunteers and interns shall:

            (a)  not be included in the youth to staff ratios;

            (b)  be under the direct and constant supervision of YCF staff;

            (c)  be provided orientation and initial training procedures.  The training must include orientation on all YCF policies and procedures;

            (d)  follow written policies and procedures developed by the YCF defining the responsibilities, limitations, and supervision of volunteers and interns; and

            (e)  complete all required background checks.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111, 52-2-111, 52-2-603, 52-2-622, MCA

IMP:  41-3-1103, 41-3-1142, 53-4-111, 52-2-111, 52-2-603, 52-2-622, MCA

 

            37.97.206  CHILD CARE AGENCY:  PERSONNEL  (1)  Each child care agency must have a written personnel policy covering the following items:  job qualifications, job descriptions, supervisory structure, salary schedules, fringe benefits, insurance, hours of work, and performance evaluations.

            (2)  Personnel records.  Each child care agency must maintain a personnel file for each employee.  The personnel file must contain:  application for employment, reports from references, record of in-service training or other training acquired after the date of hiring, reports of health examinations, and periodic performance evaluation.

            (3)  General personnel qualifications.

            (a)  All child care staff of a child care agency must meet the following general qualifications:

            (i)  understand the purpose of the child care agency and be willing to carry out its policies and programs; and

            (ii)  meet the general requirements for child care staff set out in ARM 37.97.132 and any additional qualifications for the position established by these rules.

            (4)  In-Service training.  Each child care staff member must complete 15 hours of in-service training each year, in an area directly related to the staff member's duties.  This training must be documented in each staff member's personnel file.  The training may include formal course work, workshop attendance, or the reading of appropriate literature.

            (5)  The facility shall have a policy governing emergency medical procedures.  That policy shall be fully explained to child care staff persons prior to their beginning to care for children.

            (6)  The child care agency shall employ, train and supervise an adequate number of staff necessary to ensure proper care, treatment and safety of the residents.

            (7)  No staff member, aide, volunteer or other person having direct contact with the children in the facility shall conduct themselves in a manner which poses any potential threat to the health, safety and well being of the children in care.

            (8)  The personal references of all staff shall be verified by the child care agency.

            (9)  Any staff member whose behavior or health status endangers the residents shall not be allowed at the child care agency.

            (10)  Administration.

            (a)  A child care agency must designate an administrator to direct and manage the child care agency's work in all areas.  The administrator's duties specifically include but are not limited to directing the care and services provided to children in care, personnel matters, and any other specific matters determined by the board of directors of the child care agency.

            (b)  An administrator must meet the following qualifications in addition to the general qualifications for child care staff:

            (i)  have a bachelor's degree supplemented with experience in an area relating to professional child care or appropriate graduate education;

            (ii)  have a thorough understanding of the purposes and programs of child care agencies in general; and

            (iii)  have general leadership, administrative, and management ability, including the ability to supervise child care personnel.

            (11)  Social services.

            (a)  Each child care agency must employ an adequate number of trained professionals to provide the following services for each child in care:

            (i)  to plan for a child's admission, coordinate the case plan and overall treatment plan, negotiate for the necessary resources for the child, and prepare the child for discharge and return to the family or other placement;

            (ii)  to serve as advocate for the child and liaison with the family, the referring party, and the community;

            (iii)  to prepare and maintain all required records and reports regarding the child;

            (iv)  to provide post-placement plans and services and to make the necessary referrals;

            (v)  to assist the child and staff to adjust to the child's placement; and

            (vi)  to record the child's reactions to the child care agency, school, other children, staff, and family, and to participate in staff discussion regarding progress and plans for the child.

            (b)  Those persons providing social services must meet the following qualifications in addition to the general qualifications for child care staff:

            (i)  have a bachelor's degree in a behavioral science and experience in areas related to child care or services; or

            (ii)  have a reasonable equivalent to the above.

            (c)  Maternity home staff, in addition to the above requirements, must employ an adequate number of trained professionals to provide the following services to residents:

            (i)  decision-making counseling to explore adoption and parenting options;

            (ii)  family systems counseling to explore parenting roles

and potential abuse issues; and

            (iii)  prenatal and parent training education.

            (1)  A child care agency shall employ an administrator to direct and manage the child care agency.  The administrator's duties specifically include but are not limited to directing the care and services provided to youth, personnel matters, and any other specific matters determined by the board of directors of the child care agency.

            (2)  The administrator is the person who is ultimately responsible for ensuring that the child care agency is in compliance with applicable licensing rules and ensuring that staff are familiar with and complying with all of the child care agency's policies and procedures.

            (3)  An administrator shall meet the following qualifications in addition to the general qualifications for direct care staff:

            (a)  a bachelor's degree;

            (b)  two years experience working with youth and two years experience in staff supervision and administration;

            (c)  completion of initial staff training; and

            (d)  at least 16 contact hours of annual continuing education relevant to the individual's duties and responsibilities as administrator of the child care agency.

            (4)  Each child care agency shall employ an adequate number of trained professionals to provide the following services for each youth in care:

            (a)  plan for a youth's admission, coordinate the case plan and overall treatment plan, negotiate for the necessary resources for the youth, and prepare the youth for discharge and return to the family or other placement;

            (b)  serve as advocate for the youth and liaison with the family, the referring party, and the community;

            (c)  prepare and maintain all required records and reports regarding the youth;

            (d)  provide post-placement plans and services and make the necessary referrals;

            (e)  assist the youth and staff to adjust to the youth's placement; and

            (f)  record the youth's reactions to the child care agency, school, other youth, staff, and family, and participate in staff discussion regarding progress and plans for the youth.

            (5)  Those persons providing social services shall have a bachelor's degree in a behavioral science and experience in areas related to child care or social services in addition to the general qualifications for direct care staff defined in ARM 37.97.132.

            (6)  Maternity homes shall employ an adequate number of trained professionals to provide the following services to residents:

            (a)  decision-making counseling to explore adoption and parenting options;

            (b)  family systems counseling to explore parenting roles and potential abuse and neglect issues; and

            (c) prenatal and parent education.

            (12) (7)  Education.  If a child care agency conducts a formal education program for children in care, teachers must have the same minimum qualifications as comparable teachers in the public and private schools of Montana.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 53-4-111, 53-4-113, 52-2-111, 52-2-113, 52-2-603, 52-2-622, MCA

IMP:  41-3-503, 41-3-1103, 41-3-1142, 52-2-113, 52-2-603, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.207  CHILD CARE AGENCY:  CHILD/STAFF RATIO  (1)  Each child care agency must maintain the minimum child/staff ratios set forth in this rule.

            (a)  Children of child care staff members, including foster children, who are present in the child care unit must be counted in computing child/staff ratios.

            (b)  Child care agencies other than receiving homes must use the actual number of children in care each day to compute the child/staff ratio.

            (c)  Child care agencies, other than maternity homes, must maintain the following minimum staff ratios:

            (i)  from 3:00 p.m. to 11:00 p.m., 1 to 8; and

            (ii)  from 11:00 p.m. to 3:00 p.m., 1 to 10.

            (d)  A child care agency's residential treatment center must meet the child/staff ratios set forth in ARM 37.97.250.

            (e)  Maternity homes must maintain the following minimum child/staff ratios (excluding babies being cared for by their mothers):

            (i)  from 3:00 p.m. to 10:00 p.m., 1 to 12; and

            (ii)  from 10:00 p.m. to 3:00 p.m., 1 to 16.

            (iii)  additional staff must be available for duty within 30 minutes.

            (1)  Each child care agency, except maternity homes, must maintain the minimum youth to awake staff ratios:

            (a)  from 7:00 a.m. to 11:00 p.m., 8 youth to 1 staff; and

            (b)  from 11:00 p.m. to 7:00 a.m., or any other reasonable eight-hour period of time when residents are generally sleeping, 10 youth to 1 staff.

            (2)  Maternity homes must maintain a minimum youth to awake staff ratio of 8 youth to 1 staff.

            (a)  The youth to staff ratio in a maternity home includes any child who is not being properly cared for by the youth parent who is a resident of the maternity home.

            (b)  Additional staff must be available for duty within 30 minutes of contact.

            (3)  Child care agencies must use the actual number of children in care each day to compute the youth to awake staff ratio.

 

AUTH:  41-3-503, 41-3-1142, 53-4-111, 52-2-111, 52-2-622, MCA

IMP:  41-3-503, 41-3-1142, 52-2-111, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.216  CHILD CARE AGENCY:  RECORDS  (1)  Each child care agency must shall maintain accurate and current records on each child youth in care, as follows including:

            (a)  identifying information on the youth and his the youth's family, including the child's youth's name, date and place of birth, sex, religion, race, names of relatives, and other necessary information;

            (b)  date of the child's youth's admission and name of the referring party;

            (c)  date of the child's youth's discharge and authorization for the discharge;

            (d)  documentation concerning a child's youth's specific medical problems; and

            (e)  a dated record of significant occurrences for each child youth while in care.

            (2)  Additional records to be kept by all child care agencies, except receiving homes, are as follows include:

            (a)  a copy of the court order, parental agreement, consent decree, or consent adjustment authorizing the child's youth's placement and any other pertinent court action concerning the child youth;

            (b) remains the same.

            (c)  a social study history on the child youth and his youth's family;

            (d)  psychological or psychiatric information on the child youth if psychological or psychiatric services have been provided to the child youth at any time;

            (e)  quarterly progress reports on the child's youth's reaction to the placement and services provided;

            (f)  quarterly reports from any parties providing any services to the child youth outside the child care agency; and

            (g) remains the same.

            (3)  In addition, a copy of the youth's most recent physical examination of the child must be kept by all the child care agency agencies, except receiving homes and maternity homes.

            (4)  Each child care agency must keep an accurate monthly record showing the number of children in care, the number admitted and discharged, the children's ages and sex, and the current average length of stay.  This information must be submitted to the department upon the department's request.

            (5)  Every child care agency, except receiving homes, must provide for regular periodic review of the health records of all children in care by a registered nurse or other appropriately qualified health professional to assure the continued health care of the children.

 

AUTH:  41-2-1142, 41-3-503, 41-3-1103, 52-2-111, 52-2-603, 52-2-622, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 41-3-1142, 52-2-113, 52-2-603, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.230  CHILD CARE AGENCY:  TREATMENT PROGRAM  (1)  The child care agency shall have a written description of its treatment program which shall must be made available to the youth's placing agency, and parents parent, or guardian.  The written description shall include but not be limited to:

            (a)  the name, position, and qualification of the person who has overall responsibility for the treatment program;

            (b) through (g) remain the same.

            (h)  provisions for transfer to another treatment resource when goals for treatment of a particular child youth have not been met or further treatment is required;

            (i)  description of procedures used for assessing the appropriateness of the treatment strategy for each particular child youth;

            (j)  provisions for ongoing monitoring and recording; and

            (k) remains the same.

            (2)  The treatment program shall must be designed to provide:

            (a)  adequate safeguards for the child's youth's health and welfare;

            (b) remains the same.

            (c)  utilization usage of available community resources.

 

AUTH:  41-3-1103, 53-4-113, 52-2-113, 52-2-603, MCA

IMP:  41-3-1103 52-2-603, MCA

 

5.  The department proposes to repeal the following rules:

 

            37.97.118  YOUTH CARE FACILITY, HEARING PROCEDURES, is found on page 37-23789 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 52-2-111, 52-2-602, 52-2-622, 52-2-704, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 41-3-1142, 52-2-111, 52-2-113, 53-2-201, 52-2-602, 52-2-622, 53-4-113, MCA

 

            37.97.201  CHILD CARE AGENCY:  ADMISSIONS AND DISCHARGES, is found on page 37-23823 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 53-4-111, 53-4-113, MCA

IMP:  41-3-503, 41-3-1103, 41-3-1142, 53-2-201, 53-4-113, MCA

 

            37.97.202  CHILD CARE AGENCY:  CASE PLANS, is found on page 37-23824 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1142, 53-4-111, MCA

IMP:  41-3-503, 41-3-1142, 53-2-201, 53-4-113, MCA

 

            37.97.213  CHILD CARE AGENCY:  FINANCES, is found on page 37-23839 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1142, 53-4-111, MCA

IMP:  41-3-503, 41-3-1142, 53-2-201, 53-4-113, MCA

 

            37.97.220  CHILD CARE AGENCY:  SUPERVISION OF MEDICATION, is found on page 37-23845 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111, MCA

IMP:  41-3-1103, 53-4-111, 53-4-113, MCA

 

            37.97.225  CHILD CARE AGENCY:  TIME-OUT, is found on page 37-23851 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 53-4-111, MCA

IMP:  53-2-201, 53-4-111, 53-4-113, MCA

 

            37.97.226  CHILD CARE AGENCY:  PASSIVE PHYSICAL RESTRAINT, is found on page 37-23851 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111, MCA

IMP:  41-3-1103, 53-2-201, 53-4-111, 53-4-113, MCA

 

            37.97.233  CHILD CARE AGENCY:  MANAGEMENT, is found on page 37-23856 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 53-4-113, MCA

IMP:  41-3-1103, MCA

 

            37.97.238  CHILD CARE AGENCY:  EDUCATION, is found on page 37-23857 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 53-4-113, MCA

IMP:  41-3-1103, MCA

 

            37.97.239  CHILD CARE AGENCY:  RECREATION, is found on page 37-23857 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 53-4-113, MCA

IMP:  41-3-1103, MCA

 

            37.97.250  CHILD CARE AGENCY:  RESIDENTIAL TREATMENT CENTER, STAFFING, is found on page 37-23867 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111, MCA

IMP:  41-3-1103, 41-3-1142, 53-2-201, 53-4-113, MCA

 

            37.97.253  CHILD CARE AGENCY:  RESIDENTIAL TREATMENT CENTER, EDUCATION, is found on page 37-23871 of the Administrative Rules of Montana. 

 

AUTH:  41-3-1142, 53-4-111, MCA

IMP:  53-2-201, 53-4-111, MCA

 

            37.97.254  CHILD CARE AGENCY:  RESIDENTIAL TREATMENT CENTER, RECREATION, is found on page 37-23871 of the Administrative Rules of Montana.

 

AUTH:  41-3-1142, 53-4-111, MCA

IMP:  53-4-111, 53-4-113, MCA

 

            37.97.257  CHILD CARE AGENCY:  RESIDENTIAL TREATMENT CENTER, SECLUSION, is found on page 37-23873 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111, MCA

IMP:  41-3-1103, 41-3-1142, 53-2-201, 53-4-113, MCA

 

            37.97.258  CHILD CARE AGENCY:  RESIDENTIAL TREATMENT CENTER, MECHANICAL RESTRAINT, is found on page 37-23856 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111, MCA

IMP:  41-4-1103, 41-3-1141, 41-3-1142, 53-4-11, 53-4-113, MCA

 

            37.97.259  CHILD CARE AGENCY:  RESIDENTIAL TREATMENT CENTER, CHEMICAL RESTRAINT, is found on page 37-23877 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 53-4-111, MCA

IMP:  41-3-1103, 41-3-1141, 41-3-1142, 53-4-111, 53-4-113, MCA

 

            37.97.270  CHILD CARE AGENCY:  ADDITIONAL REQUIREMENTS, is found on page 37-23878 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, 53-4-113, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.501  YOUTH GROUP HOME:  ADMINISTRATION, is found on page 37-23901 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.502  YOUTH GROUP HOME:  PROGRAM REQUIREMENTS, is found on page 37-23901 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.506  YOUTH GROUP HOME:  PHYSICAL CARE, is found on page 37-23907 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.508  YOUTH GROUP HOME:  ENVIRONMENTAL REQUIREMENTS, is found on page 37-23908 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.519  YOUTH GROUP HOME:  FIRE SAFETY, is found on page 37-23927 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.521  YOUTH GROUP HOME:  TRANSPORTATION, is found on page 37-23928 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.522  YOUTH GROUP HOME:  GUNS AND AMMUNITION, is found on page 37-23928 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.524  YOUTH GROUP HOME:  STAFF, is found on page 37-23933 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 41-3-1142, 52-2-111, 52-2-603, 52-2-622, 53-4-111, 53-4-212, MCA

IMP:  41-3-503, 41-3-1103, 41-3-1142, 52-2-113, 52-2-603, 52-2-622, 53-2-201, 53-4-113, MCA

 

            37.97.526  YOUTH GROUP HOME:  PLACEMENT AGREEMENTS, is found on page 37-23934 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.528  YOUTH GROUP HOME:  CHILDREN'S CASE RECORDS, is found on page 37-23935 of the Administrative Rules of Montana.

 

AUTH:  41-3-503, 41-3-1103, 53-4-111, MCA

IMP:  41-3-503, 41-3-1103, 53-2-201, 53-4-113, MCA

 

            37.97.801  YOUTH SHELTER CARE:  RELATIONSHIP TO YOUTH CARE FACILITY LICENSURE, is found on page 37-23961 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.805  YOUTH SHELTER CARE:  ADMINISTRATION, is found on page 37-23961 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.809  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, CARE AND GUIDANCE, is found on page 37-23967 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.810  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, NUTRITION, is found on page 37-23968 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.811  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, EDUCATION, is found on page 37-23968 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.815  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, RELIGION AND CULTURE, is found on page 37-23973 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.816  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, PERSONAL NEEDS, is found on page 37-23973 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.817  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, PRIVACY AND INDIVIDUALISM, is found on page 37-23973 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.820  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, SEARCHES, is found on page 37-23977 of the Administrative Rules of Montana. 

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.821  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, MONEY, is found on page 37-23978 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.822   YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, TRAINING AND EMPLOYMENT, is found on page 37-23978 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.825  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, DISCIPLINE, is found on page 37-23979 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.830  YOUTH SHELTER CARE:  PROGRAM REQUIREMENTS, YOUTH ORIENTATION, is found on page 37-23981 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.831  YOUTH SHELTER CARE:  PHYSICAL CARE, is found on page 37-23981 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.832  YOUTH SHELTER CARE:  ENVIRONMENT, is found on page 37-23982 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.833  YOUTH SHELTER CARE:  FIRE SAFETY, is found on page 37-23982 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.836  YOUTH SHELTER CARE:  TRANSPORTATION, is found on page 37-23985 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.837  YOUTH SHELTER CARE:  GUNS AND AMMUNITION, is found on page 37-23985 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.838  YOUTH SHELTER CARE:  STAFF, is found on page 37-23985 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.842  YOUTH SHELTER CARE:  PLACEMENT AGREEMENTS, is found on page 37-23991 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            37.97.843  YOUTH SHELTER CARE:  CASE RECORDS, is found on page 37-23991 of the Administrative Rules of Montana.

 

AUTH:  41-3-1103, 41-3-1142, 52-2-111, MCA

IMP:  41-3-1142, 52-2-113, MCA

 

            6.  The Department of Public Health and Human Services (the department) is proposing to adopt New Rules I through XLII, the amendment of ARM 37.97.101, 37.97.102, 37.97.105, 37.97.106, 37.97.110, 37.97.115, 37.97.128, 37.97.130, 37.97.132, 37.97.206, 37.97.207, 37.97.216, 37.97.230, and the repeal of 37.97.118, 37.97.201, 37.97.202, 37.97.213, 37.97.220, 37.97.225, 37.97.226, 37.97.233, 37.97.238, 37.97.239, 37.97.250, 37.97.253, 37.97.254, 37.97.257, 37.97.258, 37.97.259, 37.97.270, 37.97.501, 37.97.502, 37.97.506, 37.97.508, 37.97.519, 37.97.521, 37.97. 522, 37.97.524, 37.97.526, 37.97.528, 37.97.801, 37.97.805, 37.97.809, 37.97.810, 37.97.811, 37.97.815, 37.97.816, 37.97.817, 37.97.820, 37.97.821, 37.97.822, 37.97.825, 37.97.830, 37.97.831, 37.97.832, 37.97.833, 37.97.836, 37.97.837, 37.97.838, 37.97.842, and 37.97.843 pertaining to youth care facility licensure.

 

The department proposes to update youth care facility licensure rules for several reasons.  First, providers have requested that the rules be consolidated.  Rules for youth group homes, youth shelter care facilities, and child care agencies are located in separate subchapters, and therapeutic home rules are located in an entirely separate chapter, ARM Title 37, chapter 37, subchapter 1.  The department agrees with the provider's proposal because the requirements were difficult to use, often duplicative, and required various parts of the department to enforce the rules and review facilities for compliance.

 

Secondly, providers have been seeking dual licensure to include both youth group homes and youth shelter care facilities to alleviate the need for youth to move from shelter care to a group home placement when their circumstances change.  The department concurs with the providers, and it has determined that dual licensing is in the best interest of the youth by meeting longer placement goals without disrupting the placement of the youth. 

 

The department's Quality Assurance Division has worked collaboratively with several entities in developing the proposed new rules, including the Children's Mental Health Bureau and the Child and Family Services Division.  The proposed new rules combine the requirements for licensing, medical necessities, and contracts.  The department met with all interested providers on October 12, 2008, November 12, 2008, and July 23, 2009.

 

In order to consolidate the rules, the department found it necessary to repeal some rules because it finds that various requirements should be applied to all types of youth care facilities, and some rules are redundant or no longer necessary.

 

General requirements for all facilities are proposed to be in one subchapter.  The department proposes to put the licensing rules for therapeutic group homes (TGH) and the Medicaid TGH rules in one place for easy reference.  Repealing the TGH rules in ARM Title 37, chapter 37, subchapter 1 will allow the proposed new rules to be incorporated into the general youth care facility chapter, ARM Title 37, chapter 97.

 

The department is also proposing to repeal rules regarding child care agency, residential treatment centers (RTC).  Montana has had three licensed RTCs in the past.  This facility type has not been successful in Montana and currently none exist.  Providers have found that these facilities are too expensive to operate with the licensing requirements.  In addition, RTCs often get confused with the licensed residential treatment facilities (Acadia, Shodair, and Yellowstone Boys and Girls Ranch), which are health care facilities.  This has caused a great deal of confusion within the state and with out-of-state placements.  The RTCs are not health care facilities, therefore providers are unable to receive federal Title IV-E funding.  Also, these RTC facilities did not have the number of placements needed to provide the level of care specified by the rules.

 

Rules proposed to be repealed are ARM 37.97.118, 37.97.201, 37.97.202, 37.97.213, 37.97.220, 37.97.225, 37.97.226, 37.97.233, 37.97.238, 37.97.239, 37.97.250, 37.97.253, 37.97.254, 37.97.257, 37.97.258, 37.97.259, 37.97.270, 37.97.501, 37.97.502, 37.97.506, 37.97.508, 37.97.519, 37.97.521, 37.97. 522, 37.97.524, 37.97.526, 37.97.528, 37.97.801, 37.97.805, 37.97.809, 37.97.810, 37.97.811, 37.97.815, 37.97.816, 37.97.817, 37.97.820, 37.97.821, 37.97.822, 37.97.825, 37.97.830, 37.97.831, 37.97.832, 37.97.833, 37.97.836, 37.97.837, 37.97.838, 37.97.842, and 37.97.843.

 

Proposed changes include the addition of several safety requirements that are missing from the current rules.  The changes provide consistency throughout the youth care licensing rules.  The department also has proposed to change all references of "child" or "children" to "youth" to avoid confusion.  Both terms are defined to mean the same age group of youth served.

 

New Rule I

 

This proposed new rule is necessary to ensure that providers are continually assessing and improving the quality of their program and care.  Quality assessment is an industry standard of care.

 

New Rule II

 

Proposed New Rule II is necessary to help ensure the safety of youth served in youth care facilities.  It outlines what facility staff are to know regarding the definitions of child abuse or neglect, the mandatory reporting requirements, and procedures to deal with child abuse or neglect incidents.

 

New Rule III

 

Proposed New Rule III is necessary to incorporate federal guidelines pertaining to criminal background information of staff.  Federal law prohibits the employment of individuals working in youth care facilities who have convictions for certain offenses.  The facilities must comply with these laws in order to receive federal funds.  Providers have also requested the department to clarify what is acceptable and what is prohibited regarding criminal background information.

 

Rule IV

 

The department is proposing New Rule IV to replace ARM 37.97.524 and 37.97.838.  The ratios in this new rule remain the same.  Ratio requirements found in ARM Title 37, chapter 97, subchapters 5 and 8 are proposed to be repealed.  The requirement to add a nighttime safety protocol will increase safety for all youth and staff by allowing the facility to determine what measures are needed depending on the population the YCF serves and the level of night supervision.

 

Rule V

 

The department is proposing New Rule V in order to provide training requirements for staff to ensure that they are prepared to address the ever changing needs of the facility and the youth being served.  Staff must be prepared to deal with a wide variety of possible scenarios in youth care facilities such as how to deal with crisis and emergency situations.  Due to the difficult nature of youth being served, providers need to implement effective de-escalation methods and assure staff is trained in these procedures.  The proposed new rule provides training timelines and expectations.  Without these timelines, it is possible that staff may not be trained in a timely manner when situations arise.  Requirements for continued training give staff the opportunity to keep current with changes in youth care management and improve their knowledge and skills to deal with difficult youth.  When staff are not adequately trained to provide appropriate care, a youth may be placed at risk of harming themselves or others.

 

Rule VI

 

Proposed New Rule VI provides a process for youth who feel their rights are violated.  Such a system currently does not exist.  This proposed new rule is necessary to protect both the youth being served and the provider.

 

Rule VII

 

This proposed new rule is necessary to require providers to develop an admission policy that clearly defines the type of youth who would be appropriately served in their facilities.  Youth being placed in care have a wide variety of needs and behaviors, and one facility may not be able to do what is required for the youth.  Inappropriate placement can be harmful or disruptive to the youth, other youth in the facility, and facility staff.

 

Rule VIII

 

Proposed New Rule VIII consolidates provisions contained in the rules from each type of facility.  Changes have been made for placement agreements to ensure they do not modify any other existing agreements or contracts between the provider and the department.  It is necessary to adopt this rule to combine the requirements into one rule applicable to all facility types.   Doing so allows for easier reading for providers.

 

Rule IX

 

The department is proposing New Rule IX to apply to all facilities.  Concurrently, the requirements only apply to shelter care facilities.  This new rule is necessary to ensure that youth are adequately informed upon admission of the provider's specific program policies and expectations.  It is particularly important to inform the youth of the fire and safety issues, evacuation plans, discipline policy, and behavioral modification programs under which the provider operates.  Youth must be made aware of the daily operations and treatment requirements necessary in order to maximize the benefit of their placement.

 

Rule X

 

This proposed new rule is necessary to ensure that the youth's needs are being addressed by implementing measurable goals and objectives.  Because each youth placed has his or her own needs that the facility must address, individual case plans should be created to meet this goal.  Timelines are included to ensure that the youth's needs are being continually monitored and updated as necessary.

 

Rule XI

 

This proposed new rule combines all physical care rules that exist for each type of facility.  Doing so will decrease the number of rules and will make the requirements easier to follow.  No substantive changes were made.

 

New Rule XII

 

Proposed New Rule XII consolidates the medication requirements that are contained in several other rules.  Combining the requirements will allow youth care facilities to easily locate and comply with the requirements.  New Rule XII clearly outlines procedures for the administration, storage, and documentation of medication.  The proposed new rule helps provide for the safety of youth by ensuring that the youth is given the proper medication, in the appropriate dosage, at the appropriate time.  It further prohibits the use of medication as a means of discipline.  Proposed New Rule XII incorporates the state's Board of Nursing guidelines for documenting assistance with the self-administration of medication.

 

New Rule XIII through New Rule XXI

 

These proposed new rules consolidate the same requirements contained in the rules for each type of facility.  The substance remains unchanged.

 

New Rule XXII

 

Time-out is an allowed behavior management technique that exists in current rules, however the rules provide no guidelines.  Proposed New Rule XXII describes the appropriate use of time-out.  The department's approval of the provider's time-out policy will allow the department to maintain oversight in its use.  The department feels that it is necessary to specifically identify time-out as an individual behavior management policy because of the widespread use and various ways it is implemented.  It is important to distinguish time-out from seclusion which is prohibited as explained in the proposed new provision in ARM 37.97.102.

 

New Rule XXIII

 

New Rule XXIII is necessary to provide YCFs guidance in developing and implementing behavior management policies.  All YCFs must have clearly defined policies so the youth understand what is expected of them and know the consequences of their behaviors in order to provide the most benefits from their treatment.  Prohibited practices are clearly defined in this rule in order to protect the health and safety of the youth being served.

 

New Rule XXIV

 

Proposed New Rule XXIV provides clear guidelines in the application of crisis intervention and physical restraints.  The rule incorporates federal guidelines pertaining to physical restraints, including when the use of physical restraint is acceptable and when it is prohibited.  Since the use of physical restraints is a serious behavioral management technique and is to be used only in emergency situations, it is necessary to have strict guidelines in order to protect the youth, other facility youth, and the staff.

 

New Rule XXV

 

Proposed New Rule XXV is necessary to provide consistency in documentation for all youth who are discharged from a YCF.  It is important to have a written summary of services provided to the youth in order to evaluate the outcomes and to determine the need for continued services.

 

New Rule XXVI

 

This proposed new rule consolidates case record requirements that exist under each facility type's rules.  Additional documentation in resident case records is necessary to ensure the youth in care is receiving the appropriate level of intervention.  

 

New Rule XXVII

 

It is necessary to adopt the search and seizure requirement in proposed New Rule XXVII so that all YCFs adhere to strictly comply with youth rights.  Search requirements currently pertain to only youth shelter care facilities.  The department has determined that this new rule should be applicable to all YCFs to protect the youth served and the providers who have been entrusted in their care.

 

New Rule XXVIII

 

It is necessary to adopt proposed New Rule XXVIII to address issues of prohibited contraband within a YCF.  The new rule attempts to assure that general guidelines will be implemented consistently and equitably within that facility.  The new rule ensures that each individual facility determine what is to be considered contraband and what procedures will be followed when prohibited contraband is found.

 

New Rule XXIX

 

Proposed New Rule XXIX regarding general safety requirements for all YCFs is necessary to protect youth and staff in the YCF.  Having documented policies and procedures ensure that precautionary steps have been taken to avoid accidents or injuries.

 

New Rule XXX

 

Proposed New Rule XXX is necessary because allowing guns and other potential weapons in a YCF increases the risk of harm to youth and facility staff.

 

New Rule XXXI

 

Proposed New Rule XXXI is needed to prevent the spread of diseases.  The minimum standards specified in this rule provide YCFs with guidelines to implement an effective infection prevention and control program.

 

New Rule XXXII

 

It is necessary to address the safety concerns and health issues wherever animals and pets are allowed in a YCF.  Proposed New Rule XXXII addresses general safety requirements and allows for consistency regarding animals and pets throughout all YCFs.  This rule assists in protecting youth and facility staff from unsanitary conditions.

 

New Rules XXXIII through XXXV

 

Proposed New Rules XXXIII through XXXV consolidate the requirements found in each facility type's rules.  No substantive changes were made.

 

New Rule XXXVI

 

Proposed New Rule XXXVI should be adopted to assure that YCFs meet the minimum requirements needed for safe food preparation, handling, and sanitation.  Currently, local health departments may conduct inspections if requested by YCFs.  The department strongly encourages this practice if such inspections are available. The department's Quality Assurance Division (or QAD) worked in conjunction with the department's Food and Consumer Safety Section in proposing this rule's requirements.  This rule is necessary to prevent communicable diseases, which may cause serious health problems, from developing and spreading.

 

New Rule XXXVII

 

This proposed new rule combines the requirements found in each facility type's rules.  No substantive changes were made.

 

New Rule XXXVIII

 

The financial requirements of this proposed rule are currently required only for child care agencies.  The department has determined that the requirements should be applicable to all YCFs.  It is not unreasonable to expect that a YCF will have the resources to be financially viable for the first year of operation.  If a facility were to become licensed without the resources to continue its operation for at least one year, youth placed in the facility may be forced to move, thereby causing disruptions in their treatment.  The facility's maintenance of financial records assists the department in measuring compliance with this rule.  In the event the YCF is having financial difficulties that may result in inadequate care of the youth being served, an unbiased audit by an outside source is needed to determine if the financial difficulty places the youth at risk.  It is necessary to require the YCF to have financial responsibility for medical and dental treatment in order to ensure that the youth receive required treatment.  All YCFs are required to provide ongoing medical and dental treatment to the youth, and the facility's lack of resources should not hinder in obtaining such services.  This new rule clarifies who is responsible for the payment of those services since a variety of payment sources may be applicable.  The requirement for liability insurance allows the facility to reimburse for any costs without being placed in financial difficulty.

 

Therapeutic group homes (TGH)

 

The proposed new rules eliminate the existing three levels of care.  The majority of youth being served in TGHs meet the criteria for intensive level of care.  Eliminating the level system will have no impact on the youth being served.  Combining the license requirements for one level of care will benefit both the providers and the department.  All providers would operate under the same rules, resulting in less confusion.

 

The federal rules for TGHs do not define specific levels of care and place that responsibility on individual states to determine the appropriate standards.  As a result, the department finds it necessary to describe the services so they may be paid for by the Montana Medicaid program.  Title 42 CFR 440.130(d) states:  "Rehabilitative services, except as otherwise provided under this subpart, includes any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of this practice under state law, for maximum reduction of physical or mental disability and restoration of a recipient to his best possible functional level."  Title 42 CFR 440.40 states:  "(b) EPSDT.  Early and periodic screening and diagnosis and treatment means (1) screening and diagnostic services to determine physical or mental defects in recipients under age 21; and (2) health care, treatment, and other measures to correct or ameliorate any defects and chronic conditions discovered." 

 

New Rule XXXIX

 

Under this proposed rule, direct care staffing requirements for TGHs licensed for four or fewer youth will not change, which will result in no financial impact for the providers.  Direct care staffing requirements for TGHs licensed for five or more youth will decrease, which will result in cost savings for the providers.  If required, the providers will be able to request additional staffing and services from the department's Children's Mental Health Bureau.  The proposed new rule provides that it is not necessary to have direct care staff in the TGH if no youth is present, such as "during school hours".  This will minimize the facility's cost but still maintain adequate supervision.  Nighttime staffing only requires one direct care staff to be on duty, however, the department has determined that it is necessary for an on-call person to be available, especially since the TGH serves seriously emotionally disturbed youth and their behavior can be unpredictable.

 

Also in New Rule XXXIX the department proposes that program managers oversee no more than two TGHs.  This has been a common practice.  The quality of a program manager's duties and responsibilities may suffer if overseeing more than two TGHs.  It is unreasonable to expect program managers to perform their duties, adequately supervise the youth, and be counted in the direct care staffing ratio in several facilities.  The program manager can also serve as the lead clinical staff if he or she meets the qualifications and has sufficient time to carry out the duties of both positions.  Currently, each level of TGH care needs at least one full-time program manager for each group home.  Some need more than one because the program manager provided therapeutic care.  Following the requirements in New Rule XXXIX will result in potential cost savings for the provider.  The changes proposed for program manager have decreased requirements significantly, resulting in a potential cost savings for the provider.

 

A requirement to employ an in-training or licensed mental health professional for the lead clinical staff has been added.  Currently, treatment in the TGH can be provided by a bachelor degree level program manager, or a person with education or experience equivalent to a bachelor's degree.  The department believes that unlicensed individuals are not qualified to adequately provide therapeutic services and interventions.  The youth being served are seriously emotionally disturbed and require intensive therapeutic interventions.  A lead clinical staff educated and trained in the vast therapeutic methodologies will be able to determine the appropriate therapeutic interventions for the youth.  Due to the nature of the services provided, lead clinical staff may not be counted in the direct care staff ratio.  Because they are not available to provide direct care services to other youth when conducting therapy.

 

Permitting in-training mental health professionals to act as lead clinical staff under the supervision of a licensed professional allows the in-training individual to gain experience while helping the provider to meet its needs in providing therapeutic services.  This can serve as a recruitment tool for providers when attempting to hire lead clinical staff.  Lead clinical staff will be responsible for the direct implementation and oversight of all the youth's therapeutic needs. 

 

New Rule XXXIX is proposed to require staffing patterns to accommodate the treatment plan objectives.  Individual treatment plans can be very complex and require staff to perform additional duties depending on the youth being served.  Direct care staff is responsible for implementing certain portions of the treatment plan that occur in the therapeutic milieu.  The provider may have to adjust staffing in order to provide all requirements to the treatment plan.  If, for example, the treatment plan for a youth in the TGH includes one-on-one supervision, the facility must be adequately staffed to carry out this directive.

 

The department anticipates that this proposed rule may result in an increased fiscal impact for providers who do not currently employ lead clinical staff to provide treatment.  Based on the results of the TGH Cost Report completed in state fiscal year 2008, the department believes TGH providers will be reimbursed adequately to absorb these additional costs.  Based on the report, the average cost for TGH providers' "licensed therapies" is $23.25 per client per day.  The average cost per day for "nonlicensed observation and supports" is $148.47 per client per day.  The total of these two amounts is $171.72, which comprise the therapeutic or Medicaid reimbursed categories.  The state fiscal year 2010 Medicaid daily reimbursement rate for TGH services is $183.98.  Medicaid pays 107% of the average TGH provider cost, or 7% higher than the average TGH costs.  The Medicaid rate will adequately cover the average TGH costs.  The above costs were based on 88% occupancy rates.  If the TGH's average occupancy level is higher than 88%, their revenue to cost ratio is even higher.  The department does not foresee any impact to the department, as the rate for bundled services will remain the same.

 

The professional staffing requirements for the currently licensed campus-based TGH will be reduced under the proposed New Rule XXXIX.  Currently, staffing requires .25 social worker, .25 clinical director, .25 director of operations, and .20 registered nurse.  The duties of the clinical director have been proposed to be incorporated into the lead clinical staff position, and the duties of the director of operations and social worker have been incorporated into the program manager position.  Therefore, some reduction in staffing can be realized for providers currently licensed as campus-based TGHs, resulting in a potential cost savings.  The department proposes to remove the nurse requirements because a TGH is not a medical model, and a nurse is not required for the intensive or moderate level of care at a TGH.  Youth being served can obtain medical care from licensed health care professionals practicing in the community.  The elimination for the need of a registered nurse may provide potential cost savings to the facility.

 

New Rule XL

 

This proposed new rule is necessary to clearly define when clinical assessments are due and what the department defines as "current" in relationship to a current clinical assessment.  Without this rule, there are no clinical assessment requirements for a youth in therapeutic care, therefore the appropriate timeframes for a clinical assessment would be open to interpretation, and lead clinical staff may not have a current understanding of the youth's specific treatment needs.  The clinical assessment is necessary to identify a youth's mental health, diagnosis, and circumstances that perpetuated the placement in a therapeutic environment.  The clinical assessments need to be updated on an annual basis to document changes in the youth's mental health needs and to update the treatment plans accordingly.

 

New Rule XLI

 

This proposed new rule is necessary to identify the minimum amount of therapy that would be appropriate for a youth placed in a TGH.  The department finds that current therapy requirements are too vague and inconsistent between the levels of care in a TGH.  The new rule would implement more definitive requirements for the duration and frequency of providing psychotherapy and treatment to each youth.  The proposed new rule outlines specific requirements for individual, group, and family therapy in order to ensure the youth receive the appropriate services that are reimbursable under the Montana Medicaid guidelines.  The department believes that the youth in TGH will benefit from the rule's strengthened therapeutic requirements.

 

Commonly, a therapy session lasts for 50 minutes, however in some situations a particular youth may not be able to participate in such a lengthy therapy session.  Proposed New Rule XLI accommodates these circumstances by allowing individual therapy to be conducted within shorter timelines as indicated by the lead clinical staff.

 

Proposed New Rule XLI describes who is considered a member of the youth's family in order to participate in family therapy.  The department believes family therapy is an essential component of the youth's treatment because the goal is to return the youth to the family or similar home situation.  The department acknowledges that in extreme circumstances family therapy may not be appropriate as indicated by the lead clinical staff, social worker, or a court order.  The new rule allows the lead clinical staff to not require family therapy if it is contraindicated.

 

The documentation requirements in proposed New Rule XLI are not new, however they are more clearly defined for consistency among all providers.  Documentation of therapeutic interventions is necessary to ensure the youth's treatment plan is being implemented when the plan has therapeutic requirements.  The proposed new rule also specifies what medical records are to contain.  

 

The current requirement for internal staff meetings remains the same in proposed New Rule XLI.  A treatment meeting is a method to effectively communicate the progress of the youth's treatment plan and identify current needs and potential difficulties.  The department is reducing the requirement from two meetings per week to one because having two meetings has not shown an increased benefit for youth.

 

New Rule XLII

 

Proposed New Rule XLII is needed to indicate what treatment objectives and interventions are necessary to help the youth overcome the severe emotional disturbance or behavior disorder that resulted in placement.  Designating a review period allows for the comprehensive assessment of appropriateness of the treatment.  If the youth's treatment is not producing the desired outcomes, the treatment plan should be modified.  Staff must be aware of the treatment plan in order to provide the care needed.  Communicating the treatment plan to the placing agency and parent or guardian provides information on the objectives, interventions, and outcomes regarding the youth's treatment. 

 

ARM 37.97.102

 

The department proposes additional definitions that are used throughout the chapter, and update definitions to incorporate federal requirements.  Minor proposed changes are also provided for clarity to conform any formatting requirements to administrative rules.

 

The terms "chemical restraint", "mechanical restraint", "physical escort", "passive physical restraint", and "seclusion" have been either added or modified in accordance with federal law, which provides that these interventions are prohibited.

 

The terms "time-out" has been modified to distinguish it from seclusion.  It reflects federal language.

 

The term "serious incident" has been modified to identify what occurrences meet the level needed for reporting requirements.  The substance of this definition is the same as the current one in ARM 37.97.130, however it has been modified to include "injury to a child which requires medical attention".  Current language provides that serious incidents require hospitalization.  The definition change is necessary because youth in YCFs can be seriously injured but not require hospitalization.  These nonhospitalized injuries may be a result of a licensing violation and may require intervention.

 

The original sections in ARM 37.97.130 are proposed for deletion because they only applied to youth shelter care facilities.  The department's proposed changes will make the new definitions applicable to all youth care facilities.

 

ARM 37.97.106

 

The proposed amendment to this rule is being made to change the reference from licensing "study" to "survey", which is terminology that is common in department facility licensing.  This proposed change provides consistency among license types and eliminates confusion by using terminology that is more indicative of the requirements.  References to youth foster homes are proposed to be deleted.  Youth foster homes are considered youth care facilities, however they are licensed under ARM Title 37, chapter 51 and are regulated by the department's Child and Family Services Division.

 

ARM 37.97.110

 

It is necessary to amend this rule to provide clarification in the licensing procedure and explain the requirements needed to complete a licensing application.  The department added the requirement to submit all program policies and procedures to ensure compliance with all applicable rules in this chapter.  The rule changes give the provider a specific timeline to complete and submit the plan of correction to the department in order to ensure all licensing requirements have been met prior to issuing a license.  Designating a specific deadline to submit the plan of correction keeps the process moving forward and avoids delays in the issuance of a license.  The proposed amendments have the potential to save time and money for both the applicant and the department.

 

ARM 37.97.115

 

The proposed amendment to ARM 37.97.115 clarifies when action may be taken against a YCF when abuse or neglect occurs.  The addition of ARM 37.97.115(1)(f) is to provide more safeguards so youth are not abused or neglected.  Investigations completed by other entities have been added because the department is not the only investigator of abuse and neglect.  The rule specifically states reasons for negative licensure actions should the facility fail to provide an acceptable plan of correction, and provide recourse for an applicant or licensee impacted by the adverse licensing decision.  The department proposes to move the hearing rights provision found currently in ARM 37.97.118 into ARM 37.97.115(3) so all matters pertaining to license denial and revocation are in one rule.

 

ARM 37.97.128

 

The term "child" is being replaced by the term "youth" which appears in all proposed new rules and amendments.  No substantive changes have been made.

 

ARM 37.97.130

 

The department proposes to take out the provisions in ARM 37.97.130(3), (4), and (5), and place them in proposed new Rule II.  The serious nature of abuse, neglect, and serious incidents warrants the requirements to be more easily located in a separate rule.  A change was made to reflect the state's current child abuse and neglect reporting procedure.

 

ARM 37.97.132

The department's proposed change consolidates all requirements for staffing into one rule.  The requirements are standard conditions of employment that are used in any workplace.  These conditions are commonly used to define job duties and what qualifications are necessary to successfully perform those duties.  It is necessary for the provider to maintain personnel records.  The records provide documentation showing compliance with these rules, thereby ensuring the safety and well-being of the youth.

The department proposes to change the minimum age requirement for staff from 18 to 21 years of age.  YCFs can serve youth up to the age of 21.  The department believes it is not appropriate for staff to be younger than the youth they are in charge of caring for because the age difference may lead to potential behavior problems.  For instance, the youth may not be inclined to take direction from a younger staff member.  Requiring a high school diploma or GED for staff is necessary because the job responsibilities require the basic knowledge obtained through a high school education.

 

Changes to ARM 37.97.132 include combining all staff requirements specified in other rules.  The various requirements that currently exist for different types of facilities should be applicable to all YCFs.  One rule is also easier for operators to comprehend.

 

ARM 37.97.206

 

The amendments to ARM 37.97.206 clarify the duties of a YCF administrator to ensure that all licensing requirements are met.  The amended provisions also require additional training and educational for administrators and social service staff to ensure that they are prepared to address the changing needs of the facility and youth being served.  Due to the complexity of child care agencies, it has been determined that the administrators should be experienced in child care and also possess the administrative skills necessary to meet the duties of the position.  The administrator is responsible for overseeing the entire organization, including such areas as education, social services, finances, human resources, and program development and implementation.

 

The amendments to ARM 37.97.206 specify the education and skills necessary for social service workers to provide appropriate services to the youth and their families.  The complexity of social services has changed since these rules were originally adopted over 20 years ago.  The social service worker now must know the appropriate methodologies for treatment, the array of available services and resources, and family dynamics.  This knowledge is traditionally received through higher education.

 

ARM 37.97.207

 

The proposed amendments to this rule prohibit child care staff to have their own children at the YCF due to confidentiality and other risk factors.  The child/staff ratio for maternity homes has been modified to include children not being cared for by their mothers because staff may later be responsible to care for them.  The child/staff ratio has also been increased to provide a safe and secure environment for all residents in a maternity home, including babies and young children.

 

ARM 37.97.216

 

The department proposes to repeal the requirements in ARM 37.97.216(4) and (5) because they do not benefit the youth being served by the YCF.  Health care record reviews do not necessarily assure that the youth are receiving continued health care.  Leaving the requirements as they are may be an unnecessary expenditure for the YCF. 

 

ARM 37.97.230

 

ARM 37.97.230 is proposed to be amended to clarify who may receive the written description of the child care agency's treatment program.

 

The department rejected the option of leaving the rules as they currently exist because providers requested changes to make the rules easier to use and to accommodate dual licensure.  The department has also found that the current rules were difficult to enforce.  The proposed new rules, amendments, and repealed rules continue to provide for the safety and well-being of youth in placement while meeting both the providers and department's needs.  The current rules no longer meet the current safety standards for YCFs, criminal background criteria, and child abuse and neglect criteria.  They do not comply with the latest federal requirements.  They also fail to provide for treatment goals and objectives for higher levels of care, and address adequate levels of training for YCF staff in order for them to promote the safety and well-being of the youth.  YCFs are required to provide care and supervision to an increasingly demanding population.  These rule changes attempt to provide for those needs.

 

            7.  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: Rhonda Lesofski, 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., November 5, 2010.

 

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

 

9.  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 7 above or may be made by completing a request form at any rules hearing held by the department.

 

10.  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.

 

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

 

 

 

 

/s/  Michelle Maltese                         /s/  Anna Whiting Sorrell                              

Rule Reviewer                                   Anna Whiting Sorrell, Director

                                                            Public Health and Human Services

           

Certified to the Secretary of State September 13, 2010.

 

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