Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the adoption of New Rules I through XVIII and the amendment of ARM 37.106.322 pertaining to eating disorder centers

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NOTICE OF PUBLIC HEARING ON PROPOSED ADOPTION AND AMENDMENT

TO: All Concerned Persons

1. On October 11, 2018, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services building at 111 North Sanders, Helena, Montana, to consider the proposed adoption and amendment of the above-stated rules.

2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact the Department of Public Health and Human Services no later than 5:00 p.m. on September 28, 2018, to advise us of the nature of the accommodation that you need. Please contact Todd Olson, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

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

NEW RULE I EATING DISORDER CENTERS (EDC): APPLICATION OF OTHER RULES (1) In addition to these rules, an EDC must comply with licensure rules in ARM Title 37, chapter 106, subchapter 3. To the extent that licensure rules in ARM Title 37, chapter 106, subchapter 3 conflict with the terms of ARM Title 37, chapter 106, subchapter 12, the terms of subchapter 12 will apply to an EDC.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE II EATING DISORDER CENTERS (EDC): DEFINITIONS

(1) "Clinical director" means a social worker, psychologist, or clinical professional counselor licensed under Title 37, MCA, who oversees an EDC's clinical services. A clinical director cannot be a licensure candidate.

(2) "Eating disorder" means any of several psychological disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder, or other specific feeding or eating disorders characterized by serious disturbances to a person's eating behaviors.

(3) "Intensive outpatient program" means a program that provides more structure and support than standard outpatient therapy.

(4) "Meal support" means the provision of support during meal times, focused specifically on helping the individual to consume the food on their meal plan and redirecting behaviors that sabotage eating and recovery.

(5) "Medical director" means a psychiatrist licensed under Title 37, MCA, who oversees an EDC's services.

(6) "Mental health professional" means a psychologist, social worker, or professional counselor licensed under Title 37, MCA, or a licensure candidate registered under Title 37, MCA.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE III EATING DISORDER CENTERS (EDC): LICENSES (1) The department shall issue a license from one to three years in duration for an EDC to any applicant meeting all the requirements established by these rules and the governing statutes, as determined by the department after a licensing survey.

(2) The department will issue a renewal license for a period of one to three years in duration for an EDC if:

(a) the EDC makes written application for renewal at least 30 days prior to the expiration date of the current license; and

(b) the EDC continues to meet all requirements established by these rules and governing statutes, as determined by the department after a licensing survey.

(3) If an EDC makes timely application for renewal of a license, but the department does not complete the relicensing 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 survey and to determine compliance with licensing requirements.

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

(a) has met all licensing requirements for fire safety; and

(b) has agreed in writing to comply fully with all licensing requirements established by these rules within the time covered by the provisional license.

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

(5) The department may consider as eligible for licensure, during the accreditation period, an EDC that furnishes written evidence, including the recommendation for future compliance statements, of accreditation of its programs by the Commission on Accreditation of Rehabilitation Facilities or The Joint Commission. The department may inspect an EDC considered eligible for licensure to ensure compliance with state licensure standards.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE IV EATING DISORDER CENTERS (EDC): LICENSING PROCEDURES (1) An application for an EDC license must be made on an application form provided by the department and include plans required by ARM 37.106.306.

(2) The EDC must 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 subchapter. The EDC shall submit to the department any significant changes to policies and procedures for approval.

(3) Upon receipt of a complete application for license or renewal of license and applicable fees pursuant to 50-5-202, MCA, the department will conduct a licensing survey to determine if the applicant meets applicable licensing requirements.

(4) If the department determines during the survey that the applicant is out of compliance with applicable licensing requirements, the department will notify the applicant of the specific deficiencies, and the applicant must submit a written plan of correction within ten working days of the department's notification of noncompliance specifying how compliance will be achieved.

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

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

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE V EATING DISORDER CENTERS (EDC): SERVICES REQUIRED (1) An EDC must provide the follow services:

(a) outpatient therapy;

(b) family therapy;

(d) nutritional counseling; and

(e) crisis services.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE VI EATING DISORDER CENTERS (EDC): ELIGIBILITY FOR SERVICES (1) An EDC must have written policies and procedures for determining eligibility for services that include:

(a) the criteria to determine eligibility for services;

(b) the information required to be collected to determine eligibility for services;

(d) the procedures for accepting referrals.

(2) The EDC must have a policy and procedures for managing wait lists for services.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE VII EATING DISORDER CENTERS (EDC): CLIENT SCREENING AND ASSESSMENTS (1) An EDC must have a screening procedure for the early detection of risk of imminent harm to self or others. The procedure must:

(a) be completed on the first contact; and

(b) include a process for responding when an immediate risk of harm is identified.

(2) An EDC must complete a clinical intake assessment within three contacts, for each client, and must be updated annually.

(3) Clinical intake assessments must be conducted by a licensed mental health professional trained in clinical assessments and must include the following information in a narrative form to substantiate the client's diagnosis and provide sufficient detail to plan of care goals and objectives:

(a) presenting problem and history of problem;

(b) mental status;

(d) initial plan of care goals;

(e) risk factors to include suicidal or homicidal ideation;

(f) psychiatric history;

(g) substance use/abuse and history;

(h) current medication and medical history;

(i) financial resources and residential arrangements;

(j) education and/or work history; and

(k) legal history relevant to history of illness, including guardianships, civil commitments, criminal mental health commitments, and prior criminal background.

(4) The clinical intake assessment must include an assessment of the client's food-related behaviors including the client's beliefs, perceptions, attitudes, and behavior regarding food. The assessment may include family observations regarding the individual's food-related behavior when available.

(5) Within two weeks of admission into the program the EDC must perform or make a documented referral for the following tests, screenings, and procedures based on the needs of the client:

(a) complete blood count;

(b) comprehensive serum metabolic profile, including phosphorus and magnesium;

(d) electrocardiogram (ECG), if clinically indicated;

(e) body mass index;

(f) screenings for eating disorder behaviors; and

(g) any additional laboratory testing, as determined appropriate.

(6) The EDC may accept test results required in (5) from other health care professionals completed within two weeks prior to acceptance for services.

(7) The EDC must maintain a current list of providers who accept referrals for assessments and services not provided by the EDC.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE VIII EATING DISORDER CENTERS (EDC): PLAN OF CARE

(1) An EDC must have a multi-disciplinary plan of care that is supervised and directed by the admitting psychiatrist, and consisting of adequate numbers of individuals licensed, registered, or certified in the physical and mental health disciplines appropriate to the condition of each client.

(2) Based upon the findings of an assessment, the EDC must establish an individualized plan of care for each client within five contacts or 21 days from the first contact, whichever is later. The plan of care must:

(a) specify a diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), or the International Classification of Diseases, Tenth Revision (ICD-10);

(b) identify plan of care team members, from within and outside of the EDC, who are involved in the client's treatment and care;

(d) include objectives that include identified steps to achieve the goal;

(e) include nutritional rehabilitation to support regular and consistent weight when indicated;

(f) include measurable improvement in eating disorders behavior;

(g) identify projected timeframe for completion of goals and objectives as determined by the behavioral health needs of the client;

(h) identify the staff person responsible for each treatment service to be provided;

(i) include family participation in treatment unless such participation is contraindicated. Written documentation must indicate the reason participation is contraindicated;

(j) include signatures from the client, the client's legal guardian (if applicable), the licensed mental health professional and any other person responsible in implementation of the plan; and

(k) describe how the EDC will monitor the client's weight and food-related behaviors.

(3) The plan of care must be reviewed face-to-face at least every:

(a) 90 days for outpatient therapy;

(b) 30 days for intensive outpatient programs; or

(4) Plan of care reviews must include:

(a) the client;

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

(d) any person with responsibility in implementation of the plan;

(e) documentation on progress towards objectives and goals; and

(f) date and signature of all persons indicating participation in the review.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE IX EATING DISORDER CENTERS (EDC): GOVERNING BODY AND MANAGEMENT (1) An EDC must identify an individual or individuals to constitute its governing body. The governing body must:

(a) exercise general policy, budget, and operating direction over the EDC; and

(b) appoint an administrator of the EDC.

(2) The administrator appointed by the governing body must:

(a) have the minimum qualifications for hire as determined by the governing body;

(b) maintain daily overall management responsibility for the operation of the EDC; and

(c) develop and oversee the implementation of policies and procedures pertaining to the operation and services of the EDC.

(3) The administrator may also serve as the medical director or clinical director if the administrator meets the qualifications of the respective position.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE X EATING DISORDER CENTERS (EDC): STAFFING REQUIREMENTS (1) An EDC shall employ or contract with a medical director who must:

(a) coordinate with and advise EDC staff on medical services provided;

(b) participate in the development and approval of the program's policy and procedure manual;

(c) act as a liaison for the EDC with community physicians, hospital staff, and other professionals and agencies regarding psychiatric services; and

(d) ensure the quality of treatment and related services through participation in the EDC's quality assurance process.

(2) The EDC must:

(a) employ a clinical director;

(b) employ a registered nurse licensed under Title 37, MCA;

(d) employ the number of qualified mental health professionals and support staff necessary to adequately evaluate clients and to sufficiently participate in each individual plan of care; and

(e) employ or contract with a registered dietitian to provide for the client's nutritional needs, including assessing, educating, and counseling individuals, parents and/or legal guardians, and staff on food and nutritional related issues.

(3) The EDC must develop minimum qualifications for the hiring of all employed or contracted staff.

(4) All staff must receive orientation and training in areas relevant to the employee's duties and responsibilities, including:

(a) an overview of the EDC's policy and procedure manual in areas relevant to the staff's job responsibilities;

(b) a review of the staff's job description; and

(5) Documentation of orientation and ongoing training must be placed in the staff's personnel record.

(6) The EDC must conduct criminal background checks on all staff in accordance with EDC policy.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XI EATING DISORDER CENTERS (EDC): DISCHARGE OR TRANSFER (1) An EDC must have written policies and procedures for discharge.

(2) The EDC must develop a discharge summary for each client no longer receiving services. The discharge summary must include:

(a) reason for discharge;

(b) a summary of services provided;

(d) level of care recommendations;

(e) specific recommendations for aftercare and follow-up treatment;

(f) contact information for follow-up appointments;

(g) medication education as needed; and

(h) the signature of the staff person who prepared the report and date the summary was completed.

(3) Discharge summaries must be developed within 30 days of formal discharge from services or within 90 days of the client's last day of service when no formal discharge occurs.

(4) A copy of the discharge summary must be provided to the client or the client's legal guardian.

(5) The EDC must have a written policy and procedure to share information about the client served to facilitate coordination and continuity when the client is referred to other providers.

(6) If during the course of treatment or services the client is transferred to a hospital or inpatient program, the EDC must provide the hospital or inpatient program with the client's current condition.

(7) The EDC must establish a coordinated transfer of care through a mutually established agreement with a hospital or inpatient program.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XII EATING DISORDER CENTERS (EDC): CLINICAL RECORDS (1) An EDC's clinical records must contain the following:

(a) the name, address, date of birth, and gender of the client;

(b) the name and contact information for the client's family and any
legally authorized representative;

(d) a reason of admission for care, treatment, or services;

(e) an initial screening assessment;

(f) a clinical intake assessment;

(g) medical information including results of physical exam and laboratory testing;

(h) an initial plan of care and plan of care reviews;

(i) documentation of individual, family, and group therapy;

(j) documentation of family involvement or reason why involvement is contraindicated;

(k) documentation of consultations with a registered dietitian;

(l) documentation of monitoring the client's weight and food related behaviors as outlined in the plan of care; and

(m) a discharge summary.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XIII EATING DISORDER CENTERS (EDC): WRITTEN POLICIES AND PROCEDURES (1) In addition to requirements in ARM 37.106.330, the EDC policy and procedure manual must include information for:

(a) eligibility for services;

(b) client screenings and assessments;

(d) client rights and grievances;

(e) monitoring the client's weight and food related behaviors;

(f) maintaining clinical records;

(g) establishing fiscal policies governing the management of organizational funds;

(h) establishing and maintaining orientation and ongoing staffing requirements;

(i) informing clients of policies pertaining to the EDC;

(j) screening, hiring, and assessing staff which include conducting practices that assist the EDC in identifying employees that may pose a risk or threat to the health, safety, or welfare of any resident, and provide written documentation of the findings and the outcome in the employee's file;

(k) reporting suspected abuse or neglect in accordance with Title 52, chapter 3, part 8, MCA, for adults; and in accordance with Title 41, chapter 3, part 2, MCA, for children.

(l) reporting requirements to notify the department's Quality Assurance Division, by e-mail or fax within 24 hours, of a client, staff, volunteer, or visitor death where the death occurs on-site or in service related activities; of any fire, accident, or other incident resulting in significant damage to the service site;

(m) defining staff ethical standards and conduct, including investigating and reporting of unprofessional conduct to the applicable professional licensing authority;

(n) discharge;

(o) meal support, if applicable;

(p) the management, storage, and disposal of any prescription and over-the-counter drugs;

(q) client transportation, if provided by the EDC;

(r) crisis intervention services; and

(s) conducting staff criminal background checks including convictions that disqualify individuals from employment.

(2) The policy and procedure manual must include a current organizational chart delineating the current lines of authority, responsibility, and accountability for the administration and provision of all client services.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XIV EATING DISORDER CENTERS (EDC): CLIENT RIGHTS AND GRIEVANCES (1) An EDC must develop and maintain a rights policy that supports and protects the fundamental human, civil, constitutional, and statutory rights of all clients. These rights must include:

(a) clients are admitted to treatment without regard to race, color, creed, national origin, religion, sex, sexual orientation, age, or disability, except for bona fide program criteria;

(b) clients are reasonably accommodated in case of sensory or physical disability, limited ability to communicate, limited English proficiency, or cultural differences;

(d) all clinical and personal information is treated in accordance with state and federal confidentiality regulations;

(e) clients can review their own treatment records in the presence of the administrator or designee;

(f) clients are fully informed of fees charged, including fees for copying records to verify treatment and methods of payment available; and

(g) clients are protected from abuse, harassment, and exploitation by staff or from other clients who are on agency premises.

(2) The EDC must post a copy of client rights in a conspicuous place in the facility accessible to clients and staff.

(3) These rights must be explained at the time of admission to the client and/or legal representative in terms that the client can understand.

(4) The EDC must develop a written client grievance policy that includes:

(a) a procedure for the submission of the client's written or verbal grievance to the EDC;

(b) time frames in which the EDC must review a grievance and reach a decision;

(i) the name of the EDC's contact person;

(ii) the steps taken on behalf of the client to investigate the grievance;

(iii) the results of the grievance process; and

(iv) the date of completion.

(d) clients will receive a copy of client grievance procedures describing the submission and disposition of complaints by the client and right to appeal without threat of reprisal; and

(e) client consent must be obtained for each release of information to any other person or entity.

(5) The grievance policy must be explained at the time of admission to the client in terms that the client and/or legal representative can understand.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XV EATING DISORDER CENTERS (EDC): QUALITY ASSESSMENT (1) An EDC shall implement and maintain an active quality assessment program using information collected to make improvements in the EDC's policies, procedures, and services. The program must include procedures for:

(a) conducting client satisfaction surveys, at least annually, for all eating disorder services.

(2) The client satisfaction survey must address:

(a) whether the client, parent, or legal guardian is adequately involved in the development and review of the client's plan of care;

(b) whether the client, parent, or legal guardian was informed of client rights and the EDC's grievance procedure;

(d) the client's, parent's, or legal guardian's recommendations for improving the EDC's services; and

(e) reviewing, on an ongoing basis, incident reports, grievances, complaints, medication errors with special attention given to identifying patterns and making necessary changes in how services are provided.

(3) The EDC shall prepare and maintain on file an annual report of improvements made as a result of the quality assessment program.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XVI EATING DISORDER CENTERS (EDC): CRISIS TELEPHONE SERVICES (1) An EDC must provide crisis telephone services and comply with the following requirements:

(a) ensure that crisis telephone services are available 24 hours a day, seven days a week;

(b) an answering service or receptionists may be used to transfer calls to individuals who have been trained to respond to crisis calls;

(c) employ or contract with appropriately trained individuals, under the supervision of the medical director or clinical director, to respond to crisis calls; and

(d) ensure that a licensed mental health professional provides consultation and backup, as indicated, for unlicensed individuals responding to crisis calls.

(2) An appropriately trained individual listed in (1)(c) is one who has received training and instruction regarding:

(a) the policies and procedures of the EDC for crisis intervention services;

(b) crisis intervention techniques;

(d) the process for voluntary and involuntary hospitalization; and

(e) the appropriate utilization of community resources.

(3) The EDC must maintain documentation for each crisis call. The documentation must include:

(a) the date and time of the call;

(b) crisis responder;

(d) the nature of the emergency;

(e) risk assessment; and

(f) the result of the intervention.

(4) No individual may respond to crisis calls until the EDC documents in the individual's personnel file that the individual has received the training and instruction required in (2).

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XVII EATING DISORDER CENTERS (EDC): INTENSIVE OUTPATIENT PROGRAM (1) In addition to the requirements established in this subchapter, an EDC providing intensive outpatient programs must comply with the requirements established in this rule.

(2) Intensive outpatient programs must be available three days per week for at least three hours per day.

(3) Intensive outpatient programs must include:

(a) individual and family therapy as required by the plan of care;

(b) group therapy; and

(4) Group therapy sessions must include at least two staff members, one of which must be a mental health professional, registered nurse, or registered dietician.

(5) Intensive outpatient programs must have:

(a) a licensed mental health professional on-site during hours of operation; and

(b) additional support staff as needed in accordance with the EDC policy.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

NEW RULE XVIII EATING DISORDER CENTERS (EDC): PARTIAL HOSPITALIZATION PROGRAM (1) In addition to the requirements established in this subchapter, an EDC providing partial hospitalization programs must comply with the requirements established in this rule.

(2) Partial hospitalization services may include day, evening, night, and weekend treatment programs that must employ an integrated, comprehensive, and complementary schedule of recognized treatment or therapeutic activities.

(3) Partial hospitalization programs must operate five days per week for at least five hours per day.

(4) Partial hospitalization programs must include:

(a) individual and family therapy as required by the plan of care;

(b) group therapy;

(d) weekly medical consultations with a psychiatrist, advanced practice registered nurse, or registered nurse; and

(e) laboratory testing in accordance with the EDC's policy.

(5) Group therapy sessions must include at least two staff members, one of which must be a mental health professional, registered nurse, or registered dietician.

(6) Partial hospitalization program staff must include:

(a) a licensed mental health professional on-site during hours of operation;

(b) a registered nurse available for consultation and treatment planning during hours of operation;

(c) a licensed psychiatrist or advanced practice registered nurse available for consultation and treatment planning during hours of operation;

(d) a registered dietitian available for consultation and treatment planning during hours of operation; and

(e) additional support staff as needed in accordance with the EDC policy.

AUTH: 50-5-247, MCA

IMP: 50-5-247, MCA

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

37.106.322 MINIMUM STANDARDS FOR ALL HEALTH CARE FACILITIES: DISASTER PLAN (1) and (2) remain the same.

(3) Adult day care facilities, adult foster care homes, assisted living facilities, chemical dependency treatment centers, eating disorder centers, end-stage renal dialysis facilities, intermediate care facilities for the developmentally disabled, mental health centers, outdoor behavioral facilities, residential treatment facilities, retirement homes, and specialty mental health facilities must develop a written disaster plan for their facility, and conduct a documented review of the disaster plan with all facility staff annually. This documentation must be maintained at the facility for a minimum of three years. The disaster plan must include:

(a) through (4) remain the same.

AUTH: 50-5-103, MCA

IMP: 50-5-103, 50-5-204, MCA

5. STATEMENT OF REASONABLE NECESSITY

The 2017 Montana Legislature enacted House Bill (HB) 572, an act establishing licensure of eating disorder centers (centers) and providing rulemaking authority to the Department of Public Health and Human Services (department).

The department proposes to adopt New Rules I through XVIII establishing new minimum standards for eating disorder centers. As part of the establishment of the new standards, the department proposes to amend ARM 37.106.322 to add eating disorder centers to the department's minimum standards for all health care facilities, disaster plan requirements.

The proposed new rules have been established in accordance with HB 572 and have been written to incorporate best practice standards for eating disorder centers as established by The Joint Commission.

NEW RULE I

The department proposes to adopt this new rule to inform centers of all applicable rules that apply to licensure of eating disorder centers.

NEW RULE II

It is necessary to adopt this new rule to define terminology used throughout the rule that is not defined in statute or minimum requirements for all health care facilities administrative rules.

NEW RULE III

The department proposes to adopt this new rule to specify when a license is issued to an applicant and duration of a license.

NEW RULE IV

The department proposes to adopt this new rule to specify application and licensing survey procedures for eating disorder centers. This rule is necessary to put applicants and licensed providers on notice that a license will not be renewed or issued without an approved plan of correction.

NEW RULE V

The department proposes to adopt this new rule to establish minimum treatment services that are required for all eating disorder centers.

NEW RULE VI

The department proposes to adopt this new rule to specify that centers must write policies for determining eligibility for individuals to receive services. This rule is necessary to ensure facilities are admitting only those individuals they are qualified to serve.

NEW RULE VII

The department proposes to adopt this new rule to address the need to evaluate the client's emotional state at the time of first contact. Individuals suffering from an eating disorder may be suffering serious emotional trauma. It is necessary to require programs to complete an immediate assessment of clients to determine if they are at imminent risk to harm themselves or others and implement a process to respond when an imminent risk is identified. Once a risk is identified, the center must assist the client in receiving the appropriate care to reduce the risk of harm.

This rule is necessary to implement clinical intake assessment and medical screening requirements to provide guidelines to gather essential information from the client to be used to form a diagnostic impression and guide the delivery of the care, treatment, or services to the client. It is necessary to include an assessment of the client's food related behaviors to address specific eating disorder behaviors.

NEW RULE VIII

The department proposes to adopt this new rule to establish plan of care requirements by a multidisciplinary care, treatment, and services team that supports the continuity and provisions of care.

A plan of care is a document that details a client's current problems which is based on the findings of the required assessments. The plan of care outlines the goals and strategies that will assist the client in overcoming problems. It is necessary to implement plan of care requirements to ensure the treatment is individualized and based on the results of the assessment and conducted/overseen by qualified individuals.

It is necessary to require updates of the plan of care to ensure lack of progress is documented and addressed with a plan of care update.

NEW RULE IX

The department proposes to adopt this new rule to require eating disorder centers to assemble a governing body to oversee the operations of the center and appoint and oversee a qualified administrator. This rule is necessary to ensure centers have the appropriate oversight to provide the necessary care and treatment to clients.

NEW RULE X

The department proposes to adopt this new rule to ensure each eating disorder center has employed or contracted with appropriate qualified staff to provide safe, quality care, treatment, and service to clients. This rule is necessary to establish staff qualification and screening requirements needed to safely treat clients with eating disorders.

It is necessary to implement staff training requirements to ensure staff receive the education and training needed to provide quality care, treatment, and services.

This rule is necessary to implement House Bill 572 staffing requirements.

NEW RULE XI

The department proposes to adopt this new rule to specify discharge and transfer requirements to ensure clients and prospective treatment programs or facilities receive the necessary information required to continue care in a timely manner.

NEW RULE XII

The department proposes to adopt this new rule to specify information required in the client's clinical record to document services provided. Accurate records are essential for the continuity of care to clients. Adequate documentation allows all service providers and staff to be informed of essential information needed to provide quality services to clients.

NEW RULE XIII

The department proposes to adopt this rule to specify the requirements for eating disorder centers regarding written policy and procedures. An effective policy and procedure manual is essential for programs to maintain consistency in delivery of service. It is a tool to ensure new and existing employees understand the centers' expectations and requirements and provide guidance to all staff in the centers' specific methods and standards for how services are provided and work is performed.

NEW RULE XIV

The department proposes to adopt this new rule as it is necessary to ensure eating disorder center staff are aware of the rights given to clients. The rule provides direction to staff and clients for addressing such rights.

NEW RULE XV

The department proposes to adopt this new rule to ensure eating disorder centers conduct an internal audit regarding the quality of treatment, care, and services provided to clients. The internal audit is necessary to provide management recommendations for continuous improvement in conforming to standards, efficiency in service delivery, and client satisfaction.

NEW RULE XVI

The department proposes it is necessary to adopt this new rule to provide individuals during an emotional crisis access to a trained professional to assist them in finding resources to help them through a difficult time. An individual in crisis requires immediate assistance; therefore it is necessary to require the crisis line be available at all times.

NEW RULE XVII

The department proposes to adopt this new rule to outline requirements for centers that offer intensive outpatient programs. Intensive outpatient programs are designed to provide an additional step down from the intensity of inpatient or partial hospitalization programs while still offering more structure and support than standard outpatient therapy.

NEW RULE XVIII

The department proposes to adopt this new rule to outline requirements for centers that offer Partial Hospitalization. The therapeutic intensity of partial hospitalization programs requires a high level of structure and therapeutic interventions by a multidisciplinary team of professionals. It is necessary for the program to operate several hours per day/several days a week to deliver the high intensity treatment required at this level of care.

FISCAL IMPACT

There will be no significant financial impact to the department or providers.

6. 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: Todd Olson, 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., October 19, 2018.

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

8. 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 6 above or may be made by completing a request form at any rules hearing held by the department.

9. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The primary bill sponsor was notified by electronic mail correspondence on August 3, 2018.

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

/s/ Flint Murfitt /s/ Laura Smith

Flint Murfitt Laura Smith for Sheila Hogan, Director

Rule Reviewer Public Health and Human Services

Certified to the Secretary of State September 11, 2018.