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 III, the amendment of ARM 37.106.1902, 37.106.1906, 37.106.1916, 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965, and the repeal of ARM 37.86.2224 and 37.86.2225, pertaining to comprehensive school and community treatment program (CSCT)

) ) ) ) ) ) ) ) ) )

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

 

TO:  All Concerned Persons

 

            1.  On January 9, 2013, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed 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 January 2, 2013, to advise us of the nature of the accommodation that you need.  Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

3.  The rules as proposed to be adopted provide as follows:

 

            NEW RULE I  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM:  REFERRALS  (1)  Comprehensive school and community treatment (CSCT) services must be provided as set forth in ARM 37.106.1916, 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965 in order to receive payment under this program.

            (2)  Youth referred to the CSCT program must be served in the priority order below based upon acuity and need, regardless of payer:

            (a)  the youth is at risk of self-harm or harm to others;

            (b)  the youth requires support for transition from intensive out-of-home or community-based services;

            (c)  the youth meets the serious emotional disturbance criteria;

            (d)  the youth has not responded to positive behavior interventions and supports;

            (e)  the youth is not attending school due to the mental health condition of the youth; or

            (f)  effective July 1, 2014, the needs and strengths of the youth identified by the child and adolescent needs and strengths (CANS) assessment are such that without mental health services the youth will not be able to make positive behavioral changes.

 

AUTH:  53-2-201, 53-6-113, MCA

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

 

            NEW RULE II  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM:  CONTRACT REQUIREMENTS  (1)  The licensed mental health center providing a comprehensive school and community treatment (CSCT) program must have a written contract with the school district.

            (2)  The mental health center must identify each school in which CSCT services will be provided, including:

            (a)  specific services to be provided;

            (b)  staffing by position and minimum qualifications; and

            (c)  a description of the mental health services provided by the mental health center during and outside of normal classroom hours.

            (3)  The school must identify:

            (a)  the provision of transportation and classroom space during nonschool days as described in ARM 37.106.1956(1)(i);

            (b)  the role of the school counselor and the school psychologist, as appropriate, in the provision of mental health services and supports to youth including coordination with the CSCT program; and

            (c)  the space provided and program supports, including telephone, computer access, locking file cabinet(s), and copying, that the school will make available to CSCT staff while providing services within the school.  The treatment space provided must be adequate and appropriate for confidentiality, privacy, and the services provided.

            (4)  The school and mental health center must specify a referral process to the CSCT program that ensures youth have access to services prioritized according to acuity and need as specified in [NEW RULE I].

            (5)  The school must describe the implementation of a schoolwide positive behavior intervention and supports program, including, at a minimum, the following procedures:

            (a)  identifying youth who exhibit inappropriate behaviors to the degree that a positive behavior intervention plan is needed and youth at risk of, or suspected to have need of, mental health services;

            (b)  implementing and monitoring the progress of a positive behavior intervention plan for its effectiveness; and

            (c)  referring youth to the CSCT program when positive behavior interventions and supports have not resulted in significant positive behavioral change or when a youth may have a clinical condition and may be in need of mental health services.

            (6)  The school and mental health center must describe annual training offered to school personnel, parents, and students concerning the following:

            (a)  CSCT program and services;

            (b)  CSCT referral process and criteria;

            (c)  signs and symptoms that indicate a need for mental health services for a youth; and

            (d)  confidentiality requirements under the Family Education Rights and Privacy Act (FERPA), the Health Insurance Portability and Accountability Act (HIPPA) Privacy and Security, and the Health Information Technology for Economic and Clinical Health Act (HITECH).

            (7)  The contract must identify program data and information which will be shared between the school district and the licensed mental health center to evaluate program effectiveness to include ARM 37.106.1956(9).

            (8)  The contract must include record keeping and management, billing procedures, and must state which party is responsible for each requirement.

            (9)  In the circumstance in which a school district is the licensed mental health center providing a CSCT program, the school district must adopt an operational plan that is substantially similar to the contractual requirements set forth in this rule.  This operational plan must be kept on file and made available to the department upon request.

 

AUTH:  53-2-201, 53-6-113, MCA

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

 

            NEW RULE III  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM:  REIMBURSEMENT  (1)  Comprehensive school and community treatment (CSCT) services provided by a licensed mental health center with an endorsement under ARM 37.106.1955 must be billed under the school district's provider number.  Mental health services that are provided concurrently with CSCT are billed under the mental health center's provider number.  Outpatient therapy codes may not be billed to Medicaid by CSCT staff concurrent with Medicaid for CSCT.

            (2)  CSCT services may be provided to:

            (a)  youth ages three through five who are receiving special education services from the public school in accordance with an individualized education program (IEP) under the Individuals with Disabilities Education Act (IDEA); and

            (b)  youth ages six up to age 20, if they are enrolled in a public school.

            (3)  One team with two full-time employees may bill no more than 720 billing units per team per month.  Services must be billed in the month the service is provided.  The licensed or in-training mental health professional must provide at least half of the units billed by the team each month.

            (4)  Up to 20 CSCT units may be billed for a brief intervention, assessment, or referral for youth referred to the CSCT program, regardless of the diagnosis of the youth.

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

            (6)  The school district as a Medicaid provider of CSCT is subject to all Medicaid state and federal billing rules and regulations.  The school district must:

            (a)  use a sliding fee schedule for youth not eligible for Medicaid;

            (b)  bill all available financial resources for support of services including third party insurance and parent payments, if applicable; and

            (c)  document services to support the Medicaid reimbursement received.

            (7)  The school district must meet the certification of match requirements.

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

            (a)  a copy of the certification of match documentation, annually;

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

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

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

            (9)  Failure to provide documentation to the department in accordance with reporting requirements in (8) may result in:

            (a)  suspension of CSCT services or termination of the CSCT program for the following school year; or

            (b)  cost recovery.

            (10)  The school must submit to the department an annual report regarding the effectiveness of the CSCT program as determined in ARM 37.106.1956(9).

           

AUTH:  53-2-201, 53-6-113, MCA

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

 

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

 

            37.106.1902  MENTAL HEALTH CENTER:  DEFINITIONS  In addition to the definitions in 50-5-101, MCA, the following definitions apply to this subchapter:

            (1) through (3) remain the same.

            (4)  "Child and adolescent"  means a person 17 years of age or younger and includes students up to 21 years of age who still attend a secondary public school.

            (5)  "Child and adolescent day treatment" means a program which provides an integrated set of mental health, education and family intervention services to children or adolescents with a serious emotional disturbance.

            (6) through (8) remain the same, but are renumbered (4) through (6).

            (9) (7)  "Comprehensive school and community treatment program (CSCT)" means a comprehensive, planned course of community mental health outpatient treatment provided in cooperation and under written contract with the school district where the child or adolescent youth with a serious emotional disturbance (SED) resides attends school.  The program must be provided by a licensed mental health center with an endorsement under ARM 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965.

            (10) and (11) remain the same, but are renumbered (8) and (9).

            (12) (10)  "Individualized education program" (IEP) means a written plan developed and implemented for each student with a disability in accordance with 34 CFR 300.341 320 through 300.350 325 as revised amended as of July 1, 1995 October 30, 2007.  The department adopts and incorporates by reference 34 CFR 300.341 320 through 300.350 325.  A copy of the regulations may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953.

            (13) through (17) remain the same, but are renumbered (11) through (15).

            (18) (16)  "Licensed mental health professional" means:

            (a) remains the same.

            (b)  an occupational therapist licensed to practice in Montana who has had at least three years' experience dedicated substantially to serving persons with serious mental illnesses and is working in a child and adolescent youth day treatment program or adult day treatment program; or

            (c) remains the same.

            (19) through (25) remain the same, but are renumbered (17) through (23).

            (26) (24)  "Seclusion" means staff initiating or escorting a child or adolescent youth to a seclusion time-out room to calm down and appropriately manage their behavior.

            (27) remains the same, but is renumbered (25).

            (28) (26)  "Serious emotional disturbance" means, with respect to a youth, that the youth meets the requirements defined in ARM 37.86.3702 37.87.303.

            (29) remains the same, but is renumbered (27).

            (30) (28)  "Time-out" means staff, child or adolescent or youth initiating a time-out generally away from the group activity to enable the child or adolescent youth to calm down and appropriately manage their behavior.

            (29)  "Youth" means a person 17 years of age or younger and includes students up to 20 years of age who still attend a secondary public school.

            (30)  "Youth day treatment" means a program which provides an integrated set of mental health, education, and family intervention services to youth with a serious emotional disturbance.

 

AUTH:     50-5-103, MCA

IMP:        50-5-103, 50-5-204, MCA

 

            37.106.1906  MENTAL HEALTH CENTER:  SERVICES AND LICENSURE

            (1)  Each applicant for licensure shall must submit a license application to the department requesting approval to provide the services in (3) and may request approval to provide one or more of the services in (4).

            (2) and (3) remain the same.

            (4)  A mental health center, with the appropriate license endorsement, may provide one or more of the following services:

            (a)  child and adolescent youth intensive case management;

            (b) remains the same.

            (c)  child and adolescent youth day treatment;

            (d) through (i) remain the same.

            (5)  Each service listed in (4) that is endorsed by the department shall must be recorded on the mental health center's license.

            (6) and (7) remain the same.

            (8)  A mental health center must report to the department, in writing, any of the following changes within at least 30 days before the planned effective date of the change:

            (a) through (c) remain the same.

            (d)  a change in the name of the agency; or

            (e)  the addition of any endorsement service site; or

            (e) (f)  the discontinuation of providing a service for which the mental health center has an area of endorsement.

 

AUTH:   50-5-103, MCA

IMP:      50-5-103, 50-5-204, MCA

 

            37.106.1916  MENTAL HEALTH CENTER:  INDIVIDUALIZED TREATMENT PLANS  (1)  Based upon the findings of the assessment(s), each mental health center shall must establish an individualized treatment plan for each client within 24 hours after admission for crisis stabilization program services and within five contacts, or 21 days from the first contact, whichever is later, for other services.  The treatment plan must:

            (a) through (d) remain the same.

            (e)  include the client's or parent/legal representative/guardian's signature and date indicating participation in the development of the treatment plan.  If the client's or parent/legal representative/guardian's participation is not possible or inappropriate, written documentation must indicate the reason;

            (f) through (4) remain the same.

            (5)  A treatment team meeting for establishing an individual treatment plan and for treatment plan review must be conducted face-to-face and include:

            (a) remains the same.

            (b)  the client's legal representative/guardian if applicable;

            (c)  the client's parents or legal representative/guardian if the client is a youth and the involvement by the parent or legal representative/guardian is clinically appropriate;

            (d) through (7) remain the same.

 

AUTH:    50-5-103, MCA

IMP:      50-5-103, 50-5-204, MCA

 

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

            (3)  The program must assess the needs of a child or adolescent with a serious emotional disturbance and the appropriateness of the CSCT program to meet those needs.  As of July 1, 2014, the child and adolescent needs and strengths (CANS) assessment must be initiated for each youth with serious emotional disturbance (SED) referred to the CSCT program within fourteen calendar days of receipt of a referral cosigned by a parent or legal representative/guardian.  The CANS must be:

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

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

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

            (4)  Individuals enrolled in public school remain eligible for the CSCT program through the age of 20.  The mental health center must have a written contract with the school district in accordance with [NEW RULE II].

 

AUTH:   53-2-201, 53-6-113, MCA

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

 

            37.106.1956  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT PROGRAM (CSCT), SERVICES AND STAFFING      (1)  The CSCT program must be able to provide the following services, as clinically indicated, to children or adolescents with serious emotional disturbance, as that term is defined at ARM 37.86.3702 youth as outlined in the individualized treatment plan (ITP):

            (a) and (b) remain the same.

            (c)  other evidence and research-based practices effective in the treatment of children or adolescents youth with a serious emotional disturbance;

            (d)  direct crisis intervention services during the time the child or adolescent youth is present in a school-owned or operated facility;

            (e)  crisis intervention services by telephone during the time the child or adolescent is not present in a school-owned or operated facility a crisis plan that identifies a range of potential crisis situations with a range of corresponding responses including physically present face-to-face encounters and telephonic responses 24/7, as appropriate;

            (f)  treatment plan coordination with addictive chemical dependency and mental health treatment services the child or adolescent youth receives outside the CSCT program;

            (g) remains the same.

            (h)  referral and aftercare coordination with inpatient facilities, psychiatric residential treatment programs facilities, or other appropriate out-of-home placement programs; and

            (i)  continuous treatment that includes services during nonschool days, integrated in a manner consistent with the child or adolescent's treatment plan must be available twelve months of the year.  The program must provide a minimum of four hours per week of CSCT services in summer months and during winter and spring break.

            (2)  CSCT services for youth with serious emotional disturbance (SED) must be provided according to an individualized treatment plan designed by a licensed mental health professional who is a staff member of a CSCT program team.

            (3)  The CSCT ITP team must include:

            (a)  licensed mental health professional;

            (b)  school administrator or designee;

            (c)  parent(s) or legal representative/guardian;

            (d)  the youth, as appropriate; and

            (e)  other person(s) who are providing services, or who have knowledge or special expertise regarding the youth, as requested by the parent(s), legal representative/guardian, or the agencies.

            (4)  Providers must inform the youth and the parent(s)/legal representative/guardian that Medicaid requires coordination of CSCT with home support services and outpatient therapy.

            (5)  The CSCT program must employ sufficient qualified staff to deliver all CSCT services to youth as outlined in the ITP for the youth and in accordance with the contract between the school and mental health center.

            (6)  The CSCT program must employ or contract with a program supervisor who has daily overall responsibility for the CSCT program and who is knowledgeable about the mental health service and support needs of the youth.  The program supervisor may provide direct CSCT services, but this position may not fill the functions of the staff positions described in (6) and (7) for more than three months.

            (7)  Each CSCT team must include a mental health professional, who may be an in-training mental health professional, as defined in ARM 37.87.702(3).  In-training mental health professionals must be:

            (a)  supervised by a licensed mental health professional; and

            (b)  licensed by the last day of the calendar year following the state fiscal year (July 1 through June 30) in which supervised hours were completed.

            (8)  Each CSCT team must include a behavioral aide.  A behavioral aide must work under the clinical oversight of a licensed mental health professional and provide services for which they have received training that do not duplicate the services of the mental health professional.  All behavioral aides initially employed after July 1, 2013 must have a high school diploma and at least two years:

            (a)  experience working with emotionally disturbed youth;

            (b)  providing direct services in a human services field; or

            (c)  post-secondary education in human services.

            (3) (9)  The licensed mental health center CSCT program supervisor and an appropriate school district representative must meet at least every 90 days during the time period CSCT services are provided to mutually assess program effectiveness utilizing, but not limited to, the following indicators:

            (a)  child or adolescent progress on his or her the individual treatment plan of each youth receiving CSCT services;

            (b) remains the same.

            (c)  discipline program referrals;

            (d)  contact with law enforcement; and/or

            (e)  referral to a higher level of care.; and

            (f)  discharges from the program.

 

AUTH:    53-2-201, 53-6-113, MCA

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

 

            37.106.1960  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT (CSCT) PROGRAM, STAFFING AND PERSONNEL TRAINING  (1)  The licensed mental health center's CSCT program must be provided through a program of services delivered by a team or teams.  The CSCT program must be delivered by adequately trained staff.  Training should be competency-based and must be documented and maintained in personnel files.

            (2)  Each team must consist of a full-time equivalent licensed mental health professional, as that term is defined in ARM 37.106.1902, and an aide.  An in-training mental health practitioner pursuant to ARM 37.88.901 may be a team member. Full-time equivalent is defined in ARM 37.27.102.  All CSCT program staff are required to receive a minimum of 18 hours of orientation training during the first three months of employment which addresses all of the following:

            (a)  certified de-escalation training inclusive of physical and nonphysical methods;

            (b)  child development;

            (c)  behavior management;

            (d)  crisis planning;

            (e)  roles and responsibilities of CSCT staff in the school setting;

            (f)  school culture;

            (g)  confidentiality requirements;

            (h)  staff and program supervision; and

            (i)  CSCT program procedures.

            (3)  A full-time equivalent team is limited to the billing amounts as set forth in ARM 37.86.2225.

            (4)  A CSCT program must employ or contract with a program supervisor who is knowledgeable about the service and support needs of children and adolescents with serious emotional disturbances.  The program supervisor may be a member of a team providing direct services.

            (5)  This rule is not intended to prevent the use of part-time staff to provide CSCT services throughout the year, including school vacation periods.  If a child or adolescent receives CSCT services during time periods when school is not regularly in session, then part-time staff may be used and billed as set forth in ARM 37.86.2225.

            (6)  The licensed mental health center's CSCT program must be delivered by adequately trained staff.  Training must be documented and maintained in the personnel files.

            (7)  If a nonlicensed team member is employed, that individual must have a high school diploma or a general education degree (GED) and one year of relevant experience.

            (a)  The nonlicensed team member must receive ten hours of training during the first three months of employment that includes de-escalation training, child development, and how and when to implement behavior management.  The ten hours of initial training may be combined with the required 18 hours of annual training mandated for all team members.

(8) (3)  All team members program staff are required to receive a minimum of 18 hours training per year in behavior management strategies that focus on the prevention of behavior problems for children or adolescents youth with serious emotional disturbance (SED).  Training must include:

            (a) remains the same.

            (b)  classroom and child or adolescent youth behavior management techniques that include nationally certified de-escalation training inclusive of physical and nonphysical methods;

            (c)  evidence and research-based behavior interventions and practices; and

            (d)  therapeutic de-escalation of crisis situations for the protection and safety of the clients and staff; and progress monitoring techniques to inform treatment decisions.

            (e)  physical and nonphysical methods of managing children and adolescents.

 

AUTH:    53-2-201, 53-6-113, MCA

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

 

            37.106.1961  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT (CSCT) PROGRAM, CLIENT RECORD REQUIREMENTS  (1)  In addition to any clinical records required in ARM 37.85.414 or elsewhere in these rules, the licensed mental health center's CSCT program must maintain the following client records for youth with serious emotional disturbance (SED):

            (a)  progress notes for each individual therapy and other direct services a written referral cosigned by the parent(s) or legal representative/guardian, which documents the reason for the referral;

            (b)  monthly overall progress notes; and a copy of the clinical assessment which documents the presence of SED;

            (c)  individual outcomes compared to baseline measures and established benchmarks. the individualized treatment plan for CSCT;

            (d)  progress notes for each individual therapy session and other direct services provided to the youth and family;

            (e)  90-day treatment plan reviews; and

            (f)  discharge plan.

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

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

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

            (b)  progress notes for each individual therapy session and other direct services provided to the youth and family; and

            (c)  discharge plan with referral to additional services, if appropriate.

            (4)  Records for youth referred to CSCT and denied acceptance into the program must include the following:

            (a)  a written referral with the reason for the referral; and

            (b)  documentation detailing the reason for the denial.

 

AUTH:    53-2-201, 53-6-113, MCA

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

 

            37.106.1965  MENTAL HEALTH CENTER:  COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT (CSCT) PROGRAM, SPECIAL EDUCATION REQUIREMENTS  (1)  The licensed mental health center's CSCT program must be coordinated with the child or adolescent's special education program of the youth, if any the youth is identified as a child with a disability and is receiving special education services under the individuals with disabilities education act (IDEA).

            (2)  If a client has a child study team (CST), as that term is used in Title 20, MCA, the CSCT team assigned to the child or adolescent must attend CST meetings and individualized education plan (IEP) meetings when clinically indicated and permitted under state and federal law.  The licensed mental health professional or behavioral aide, as appropriate, must attend the individualized education plan (IEP) meeting when requested by the parent/legal representative/guardian or the school.

            (3)  A copy of the IEP must be included in the child or adolescent's treatment plan.

 

AUTH:     53-2-201, 53-6-113, MCA

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

 

5.  The department proposes to repeal the following rules:

 

37.86.2224  EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT SERVICE (EPSDT), COMPREHENSIVE SCHOOL AND COMMUNITY TREATMENT, is found on page 37-20331 of the Administrative Rules of Montana.

 

AUTH:  53-2-201, 53-6-113, MCA

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

 

            37.86.2225  EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT SERVICES (EPSDT), CSCT PROGRAM BILLING, is found on page 37-20332 of the Administrative Rules of Montana.

 

AUTH:   53-2-201, 53-6-113, MCA

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

 

            6.  STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) proposes to adopt New Rules I through III, amend ARM 37.106.1902, 37.106.1906, 37.106.1916, 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961, and 37.106.1965, and repeal ARM 37.86.2224 and 37.86.2225 pertaining to the comprehensive school and community treatment program (CSCT).

 

The current CSCT rules were last amended in May of 2006.  With the CSCT Program moving to the children's Mental Health Bureau (CMHB) from the Health Resources Division (HRD), substantial changes to the current language are needed.  The proposed new rules provide more specificity to reflect the move from HRD to CMHB and to align them with recommendations from the multidisciplinary workgroup tasked with evaluating the rules.  Rule amendments are being proposed in Title 37, chapter 86, and chapter 106 and new rules are being adopted in chapter 87 in cooperation between the Quality Assurance Division and the Children's Mental Health Bureau.

 

New Rule I

 

The department is proposing New Rule I which adds the requirements for a referral system that would prioritize caseload by acuity.  These requirements are necessary to ensure that the neediest youth are served first.

 

New Rule II

 

The department is proposing New Rule II to require certain elements to be in place in contracts between schools and mental health centers.  These elements include:  staffing, space, roles, referral process, implementation of a positive behavior intervention and supports program, and provision for data collection and records management.  This rule is necessary to ensure that an understanding exists between schools and mental health centers about the services to be provided through the CSCT program and to promote program uniformity statewide.

 

ARM 37.106.1956(3) is being renumbered to ARM 37.106.1956(9) because new text has been added to this section of rule.

 

New Rule III

 

The department is proposing New Rule III to contain provisions requiring providers to meet certain conditions in order to be reimbursed by Medicaid for services.  This rule is necessary because it would provide eligibility criteria for youth and providers.

 

New Rule III also introduces a new option for schools choosing to include it in their array of CSCT services:  an intervention, assistance, and referral program for youth without serious emotional disturbance.  This option was included at the request of schools where CSCT is either the sole access point for mental health services or the least intimidating access point for families.

 

ARM 37.106.1956(3) is being renumbered to ARM 37.106.1956(9) because new text has been added to this section of rule.

 

ARM 37.106.1902

 

The department is proposing to amend this rule to remove reference to "child or adolescent," replacing with "youth" to be consistent with the department's preferred language.  It revises the definition of comprehensive school and community treatment to include the need for a contract, the addition of tribes as providers, to clarify that CSCT takes place where a youth attends school, and updates the reference to the code of federal regulations pertaining to individualized education plans.

 

ARM 37.106.1906

 

The department is proposing amending this rule to replace "child or adolescent" with "youth" and add a requirement that mental health centers inform the department, in writing, upon addition of any CSCT service site.  Informing the department of service site additions is necessary as without the information quality assurance activities are not possible.

 

ARM 37.106.1916

 

The department is proposing amending this rule to add the term "legal representative" in order to align this rule with the language being used in the children's mental health bureau rules.  This is necessary to maintain consistency.

 

ARM 37.106.1955

 

The department is proposing amending this rule to include a specific requirement after July 1, 2014 that the child and adolescent needs and strengths (CANS) assessment be conducted for each youth with a serious emotional disturbance referred to the program.  This is necessary so that the department can begin to collect data on the population served to improve programs and also to improve on-the-ground treatment planning.  The proposed rule also references contract requirements in Title 37, chapter 87 and removes eligibility criteria which have more appropriately been placed in New Rule III.

 

ARM 37.106.1956

 

The department is proposing amending this rule to specify services and staffing requirements that have previously been unclear to providers.  The proposed rule specifies that crisis services must be provided to youth in and outside of school.  This is necessary in order to ensure that CSCT is truly a comprehensive service.  The amended rule also requires minimal contact for breaks and holidays, again ensuring that CSCT is truly a comprehensive service.  The proposed rule language specifically states who is required to attend treatment plan meetings to ensure representation from both the school and the mental health centers.  This is important because CSCT is a school-based service.  In order to improve program performance, the proposed rule is more specific than rules have been in the past regarding the experience requirements of CSCT team members and the supervisor.

 

ARM 37.106.1960

 

The department is proposing amending ARM 37.106.1960 to remove staffing requirements from the rule as they are more appropriately covered in ARM 37.106.1956.  The proposed changes also specify training requirements at orientation and for ongoing staff.  Systematic training requirements are necessary in order to ensure that CSCT staff persons are delivering quality programs to youth.

 

ARM 37.106.1961

 

The department is proposing amending ARM 37.106.1961 to specify records requirements for youth's CSCT files.  This rule change is necessary to be consistent with treatment plan requirements.

 

ARM 37.106.1965

 

The department is proposing amending ARM 37.106.1965 to make a wording change that explains that coordination with special education is required if a youth has both an individualized education plan (IEP) and a CSCT individualized treatment plan.  This change is necessary because the previous version of the rule seemed to indicate that a youth would have both as a matter of course.  The rule change would also make clear that a member of the CSCT team would attend the IEP meeting if requested by the parent or legal representative.  This change is necessary in many instances to foster coordination.  

 

ARM 37.86.2224 and 37.86.2225

 

The department is proposing to repeal these rules because the proposed new rules and the rule amendments to Title 37, chapter 106 now provide the guidance regarding CSCT.

 

Fiscal Impact

 

The proposed rule amendments will not impact the state general fund. The CSCT program is funded by Medicaid with the public schools providing the certified match monies.  However, there would be a federal fiscal impact if the change allowing for 20 units of CSCT for youth not diagnosed with a serious emotional disturbance results in an increase in the total number of CSCT teams.  This change to the program has the potential to cost up to $3.9 million over the next two state fiscal years (SFY).  The federal portion of this will depend on the federal medical assistance percentages (FMAP), but currently the federal component makes up about two-thirds of the total expenditures.  Schools would have to be able to meet the certification of match requirements for the remaining third.  The increase in matching dollars provided by schools could be up to $1.3 million more than currently provided over the next two SFYs.

 

CSCT currently serves more than 4,000 youth per year.

 

            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: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., January 17, 2013.

 

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/ Kurt R. Moser                                           /s/ Mary E. Dalton acting for                      

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services

           

Certified to the Secretary of State December 10, 2012.